| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $31 | $43 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $20 | $33 |
| Immunization admin injection single CPT 90471 • Preventive Care | $3 | $29 | $43 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $1 | $22 | $33 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $34 | $238 | $376 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $231 | $391 | $648 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $10 | $80 | $117 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $2 | $27 | $54 |
| MMR vaccine CPT 90707 • Preventive Care | $72 | $96 | $111 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $6 | $54 | $96 |
| Varicella vaccine CPT 90716 • Preventive Care | $29 | $142 | $219 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $67 | $179 | $335 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $48 | $149 | $246 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $62 | $154 | $249 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $7 | $164 | $260 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $10 | $170 | $270 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $57 | $147 | $265 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $79 | $204 | $298 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $97 | $199 | $270 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $53 | $226 | $373 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $53 | $128 | $194 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $45 | $122 | $207 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $9 | $119 | $172 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $35 | $174 | $261 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $49 | $129 | $176 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $8 | $176 | $287 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $9 | $192 | $308 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $35 | $65 | $100 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $44 | $197 | $490 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $20 | $403 | $928 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $202 | $426 | $552 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $92 | $223 | $323 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $158 | $216 | $333 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $106 | $176 | $225 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $41 | $447 | $694 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $30 | $491 | $763 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $55 | $297 | $722 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $29 | $623 | $973 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $34 | $500 | $1,035 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $206 | $2,049 | $3,182 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $93 | $144 | $245 |
| Spirometry CPT 94010 • Pulmonology | $8 | $31 | $68 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $13 | $42 | $67 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $68 | $71 | $77 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $42 | $52 | $62 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $34 | $210 | $412 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $3 | $20 | $45 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $17 | $26 | $43 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $13 | $31 | $61 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $33 | $43 | $48 |