| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $12 | $16 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $7 | $12 |
| Immunization admin injection single CPT 90471 • Preventive Care | $2 | $9 | $16 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $2 | $8 | $12 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $137 | $247 | $329 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $257 | $258 | $258 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $14 | $69 | $102 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $21 | $22 | $22 |
| MMR vaccine CPT 90707 • Preventive Care | $47 | $79 | $97 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $6 | $31 | $50 |
| Varicella vaccine CPT 90716 • Preventive Care | $163 | $173 | $192 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $67 | $92 | $117 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $37 | $126 | $216 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $16 | $66 | $106 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $12 | $79 | $113 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $115 | $116 | $118 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $101 | $116 | $131 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $14 | $90 | $129 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $17 | $83 | $117 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $19 | $113 | $162 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $48 | $73 | $97 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $37 | $81 | $104 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $76 | $89 | $102 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $11 | $62 | $114 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $9 | $61 | $88 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $47 | $98 | $124 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $15 | $93 | $133 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $3 | $23 | $38 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $28 | $125 | $183 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $51 | $234 | $338 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $18 | $102 | $186 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $162 | $163 | $163 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $163 | $164 | $167 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $113 | $122 | $127 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $30 | $169 | $243 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $20 | $183 | $273 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $30 | $139 | $252 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $52 | $243 | $348 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $172 | $235 | $348 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $222 | $713 | $1,278 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $91 | $91 | $92 |
| Spirometry CPT 94010 • Pulmonology | $18 | $23 | $25 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $13 | $23 | $30 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $29 | $30 | $32 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $14 | $15 | $15 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $30 | $89 | $155 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $2 | $10 | $17 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $3 | $10 | $16 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $10 | $25 | $52 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $8 | $27 | $42 |