| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $14 | $18 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $9 | $13 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $12 | $14 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $11 | $13 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $312 | $312 | $312 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $245 | $253 | $258 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $92 | $104 | $115 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $25 | $25 | $25 |
| MMR vaccine CPT 90707 • Preventive Care | $92 | $93 | $93 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $56 | $56 | $56 |
| Varicella vaccine CPT 90716 • Preventive Care | $16 | $116 | $217 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $13 | $62 | $111 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $37 | $121 | $205 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $85 | $97 | $109 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $111 | $149 | $187 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $67 | $91 | $116 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $97 | $102 | $107 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $160 | $160 | $160 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $147 | $181 | $247 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $156 | $156 | $156 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $93 | $93 | $93 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $102 | $125 | $172 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $81 | $92 | $102 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $109 | $110 | $112 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $193 | $193 | $193 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $123 | $141 | $158 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $81 | $104 | $133 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $37 | $38 | $38 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $53 | $150 | $213 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $55 | $127 | $180 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $127 | $136 | $145 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $131 | $187 | $266 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $130 | $152 | $163 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $127 | $147 | $185 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $41 | $217 | $393 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $437 | $437 | $437 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $30 | $112 | $194 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $30 | $76 | $122 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $30 | $76 | $167 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $364 | $821 | $1,278 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $87 | $89 | $91 |
| Spirometry CPT 94010 • Pulmonology | $30 | $37 | $43 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $30 | $63 | $95 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $23 | $23 | $23 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $11 | $21 | $30 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $54 | $54 | $54 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $17 | $17 | $17 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $13 | $24 | $30 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $9 | $31 | $53 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $24 | $35 | $50 |