| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $9 | $11 |
| Immunization admin injection single CPT 90471 • Preventive Care | $3 | $15 | $30 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $2 | $12 | $25 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $50 | $196 | $329 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $231 | $273 | $331 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $10 | $67 | $102 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $2 | $22 | $42 |
| MMR vaccine CPT 90707 • Preventive Care | $21 | $73 | $102 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $4 | $36 | $54 |
| Varicella vaccine CPT 90716 • Preventive Care | $98 | $148 | $192 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $27 | $72 | $117 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $36 | $134 | $216 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $6 | $69 | $137 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $35 | $99 | $164 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $35 | $80 | $131 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $17 | $103 | $179 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $40 | $102 | $159 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $66 | $120 | $167 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $107 | $157 | $218 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $8 | $68 | $137 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $6 | $77 | $135 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $88 | $98 | $115 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $97 | $116 | $154 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $10 | $87 | $152 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $40 | $102 | $162 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $9 | $86 | $164 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $5 | $14 | $23 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $129 | $134 | $140 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $40 | $192 | $269 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $75 | $203 | $270 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $92 | $115 | $138 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $142 | $150 | $158 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $96 | $122 | $163 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $137 | $168 | $198 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $113 | $131 | $150 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $124 | $180 | $209 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $72 | $175 | $278 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $16 | $156 | $296 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $154 | $471 | $788 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $78 | $86 | $93 |
| Spirometry CPT 94010 • Pulmonology | $9 | $15 | $22 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $15 | $32 | $48 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $25 | $34 | $41 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $20 | $27 | $34 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $34 | $54 | $73 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $13 | $20 | $34 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $4 | $9 | $14 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $10 | $25 | $48 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $13 | $22 | $35 |
| Diffusing capacity (DLCO) CPT 94729 • Pulmonology | $8 | $24 | $53 |