| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $18 | $24 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $8 | $12 |
| Immunization admin injection single CPT 90471 • Preventive Care | $2 | $15 | $24 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $5 | $12 | $18 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $41 | $229 | $329 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $197 | $229 | $258 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $16 | $72 | $102 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $11 | $17 | $22 |
| MMR vaccine CPT 90707 • Preventive Care | $9 | $66 | $97 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $38 | $42 | $50 |
| Varicella vaccine CPT 90716 • Preventive Care | $16 | $131 | $192 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $113 | $121 | $133 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $24 | $138 | $216 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $9 | $72 | $106 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $33 | $77 | $111 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $15 | $72 | $116 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $50 | $85 | $105 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $103 | $119 | $127 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $106 | $129 | $148 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $16 | $71 | $126 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $6 | $58 | $100 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $37 | $76 | $102 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $45 | $78 | $102 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $97 | $107 | $112 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $35 | $86 | $115 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $47 | $98 | $123 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $10 | $75 | $116 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $21 | $30 | $37 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $54 | $107 | $159 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $34 | $211 | $364 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $235 | $284 | $364 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $133 | $147 | $161 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $130 | $146 | $166 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $103 | $117 | $127 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $36 | $165 | $294 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $21 | $171 | $320 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $252 | $278 | $303 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $125 | $253 | $382 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $129 | $152 | $189 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $103 | $484 | $865 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $91 | $92 | $92 |
| Spirometry CPT 94010 • Pulmonology | $23 | $26 | $30 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $13 | $30 | $45 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $29 | $33 | $38 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $23 | $29 | $37 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $68 | $68 | $68 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $5 | $10 | $17 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $16 | $16 | $17 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $12 | $36 | $50 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $30 | $36 | $40 |