| Immunization admin first vaccine component CPT 90460 • Preventive Care | $22 | $32 | $53 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $13 | $30 |
| Immunization admin injection single CPT 90471 • Preventive Care | $3 | $28 | $53 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $1 | $14 | $30 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $50 | $238 | $336 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $230 | $240 | $258 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $16 | $74 | $104 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $20 | $21 | $22 |
| MMR vaccine CPT 90707 • Preventive Care | $97 | $100 | $103 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $39 | $43 | $50 |
| Varicella vaccine CPT 90716 • Preventive Care | $20 | $136 | $195 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $20 | $90 | $133 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $48 | $132 | $216 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $10 | $114 | $236 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $11 | $121 | $247 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $104 | $161 | $257 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $40 | $122 | $215 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $113 | $176 | $281 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $20 | $156 | $324 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $129 | $181 | $269 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $53 | $133 | $213 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $9 | $99 | $227 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $45 | $136 | $227 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $7 | $93 | $183 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $91 | $155 | $253 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $16 | $109 | $204 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $9 | $149 | $290 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $29 | $63 | $125 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $19 | $337 | $655 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $56 | $303 | $650 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $40 | $458 | $1,205 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $91 | $160 | $288 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $125 | $215 | $361 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $98 | $162 | $282 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $30 | $258 | $470 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $12 | $432 | $983 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $265 | $590 | $914 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $14 | $290 | $557 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $161 | $588 | $1,334 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $21 | $550 | $839 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $93 | $161 | $296 |
| Spirometry CPT 94010 • Pulmonology | $26 | $33 | $38 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $34 | $74 | $122 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $38 | $100 | $195 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $15 | $29 | $46 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $76 | $176 | $268 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $3 | $26 | $48 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $4 | $30 | $53 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $39 | $49 | $61 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $14 | $54 | $99 |