| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $11 | $12 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $7 | $11 |
| Immunization admin injection single CPT 90471 • Preventive Care | $5 | $9 | $12 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $2 | $7 | $11 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $79 | $196 | $312 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $231 | $249 | $271 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $10 | $54 | $97 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $4 | $13 | $21 |
| MMR vaccine CPT 90707 • Preventive Care | $10 | $51 | $92 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $6 | $27 | $47 |
| Varicella vaccine CPT 90716 • Preventive Care | $23 | $103 | $182 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $21 | $91 | $140 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $28 | $164 | $258 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $61 | $73 | $85 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $12 | $38 | $63 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $9 | $38 | $67 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $17 | $61 | $105 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $66 | $84 | $102 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $95 | $106 | $117 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $9 | $68 | $128 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $54 | $64 | $82 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $5 | $50 | $87 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $44 | $63 | $87 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $58 | $72 | $89 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $7 | $58 | $97 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $39 | $68 | $97 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $79 | $95 | $111 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $4 | $13 | $22 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $10 | $73 | $135 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $116 | $162 | $255 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $59 | $124 | $255 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $109 | $115 | $126 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $109 | $116 | $130 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $86 | $88 | $91 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $56 | $80 | $103 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $123 | $165 | $207 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $12 | $59 | $105 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $134 | $200 | $265 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $44 | $81 | $137 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $381 | $613 | $846 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $71 | $83 | $89 |
| Spirometry CPT 94010 • Pulmonology | $7 | $23 | $40 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $10 | $11 | $12 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $23 | $25 | $28 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $18 | $25 | $30 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $54 | $62 | $70 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $12 | $23 | $44 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $13 | $25 | $44 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $9 | $19 | $28 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $10 | $26 | $45 |