| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $12 | $15 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $8 | $14 |
| Immunization admin injection single CPT 90471 • Preventive Care | $5 | $10 | $15 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $11 | $14 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $50 | $253 | $372 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $230 | $251 | $292 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $16 | $79 | $116 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $20 | $22 | $25 |
| MMR vaccine CPT 90707 • Preventive Care | $100 | $104 | $109 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $39 | $45 | $57 |
| Varicella vaccine CPT 90716 • Preventive Care | $195 | $203 | $217 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $132 | $133 | $133 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $120 | $194 | $244 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $18 | $101 | $170 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $84 | $128 | $178 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $64 | $125 | $185 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $81 | $124 | $209 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $101 | $130 | $151 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $18 | $138 | $235 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $124 | $165 | $197 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $53 | $89 | $153 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $67 | $103 | $163 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $12 | $79 | $162 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $9 | $96 | $179 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $13 | $98 | $183 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $133 | $139 | $149 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $22 | $89 | $157 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $13 | $32 | $47 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $9 | $76 | $133 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $93 | $189 | $285 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $118 | $249 | $510 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $115 | $154 | $193 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $103 | $174 | $260 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $70 | $106 | $176 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $25 | $202 | $329 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $33 | $222 | $367 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $113 | $148 | $182 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $27 | $254 | $470 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $73 | $155 | $238 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $374 | $877 | $1,511 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $86 | $108 | $152 |
| Spirometry CPT 94010 • Pulmonology | $33 | $38 | $45 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $13 | $58 | $99 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $33 | $63 | $98 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $20 | $28 | $41 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $65 | $127 | $165 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $10 | $19 | $30 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $28 | $31 | $33 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $20 | $39 | $54 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $21 | $46 | $73 |