| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $14 | $21 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $7 | $10 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $13 | $19 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $13 | $14 | $14 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $67 | $219 | $371 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $230 | $251 | $292 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $104 | $108 | $115 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $3 | $16 | $25 |
| MMR vaccine CPT 90707 • Preventive Care | $21 | $64 | $109 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $39 | $49 | $56 |
| Varicella vaccine CPT 90716 • Preventive Care | $98 | $140 | $217 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $67 | $111 | $133 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $24 | $162 | $244 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $9 | $80 | $147 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $13 | $70 | $108 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $91 | $99 | $115 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $103 | $145 | $181 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $10 | $104 | $175 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $89 | $146 | $203 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $19 | $121 | $220 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $8 | $69 | $133 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $29 | $65 | $101 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $83 | $99 | $114 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $6 | $80 | $154 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $10 | $85 | $158 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $93 | $114 | $128 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $131 | $156 | $181 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $4 | $26 | $37 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $53 | $157 | $248 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $78 | $349 | $510 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $32 | $220 | $458 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $134 | $172 | $226 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $157 | $180 | $225 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $131 | $146 | $176 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $97 | $137 | $178 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $129 | $153 | $178 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $49 | $212 | $343 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $211 | $312 | $414 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $34 | $248 | $500 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $233 | $951 | $1,669 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $88 | $101 | $126 |
| Spirometry CPT 94010 • Pulmonology | $8 | $23 | $36 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $7 | $27 | $37 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $12 | $51 | $82 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $7 | $14 | $20 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $29 | $89 | $145 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $12 | $14 | $17 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $8 | $15 | $22 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $16 | $40 | $52 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $12 | $34 | $58 |