| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $16 | $27 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $12 | $21 |
| Immunization admin injection single CPT 90471 • Preventive Care | $18 | $23 | $27 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $1 | $9 | $16 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $59 | $236 | $336 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $231 | $248 | $272 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $25 | $61 | $97 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $20 | $24 | $32 |
| MMR vaccine CPT 90707 • Preventive Care | $92 | $93 | $93 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $6 | $26 | $46 |
| Varicella vaccine CPT 90716 • Preventive Care | $115 | $149 | $182 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $28 | $91 | $133 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $202 | $247 | $282 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $30 | $90 | $181 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $10 | $96 | $190 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $49 | $140 | $198 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $169 | $182 | $195 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $143 | $192 | $216 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $117 | $157 | $197 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $128 | $200 | $272 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $6 | $66 | $116 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $111 | $138 | $175 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $30 | $50 | $60 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $48 | $109 | $191 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $170 | $183 | $195 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $123 | $171 | $208 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $8 | $44 | $79 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $9 | $23 | $37 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $20 | $43 | $74 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $12 | $133 | $255 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $23 | $135 | $246 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $163 | $206 | $272 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $130 | $191 | $281 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $88 | $114 | $127 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $106 | $146 | $187 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $48 | $198 | $348 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $22 | $174 | $326 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $44 | $244 | $444 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $137 | $177 | $217 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $36 | $719 | $1,403 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $89 | $100 | $122 |
| Spirometry CPT 94010 • Pulmonology | $19 | $32 | $45 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $17 | $56 | $96 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $35 | $37 | $38 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $14 | $25 | $44 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $44 | $83 | $122 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $11 | $26 | $44 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $21 | $25 | $30 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $31 | $44 | $56 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $23 | $34 | $45 |