Life stage
Preventive care for adults on Medicare
What Medicare beneficiaries should expect to pay (or not pay) for preventive and routine care. Many of these are covered with no cost-sharing under Part B; we surface the gross and cash sticker prices for context.
Procedures
50
in this collection
With data on file
50
0 pending hospital coverage
Hospital-procedure pairs
1,804
reported across CO
CMS shoppable
9 of 50
on the federal mandate list
Procedures in this collection
Shingrix (Shingles Vaccine)
Two-dose recombinant zoster vaccine to prevent shingles. The CDC recommends Shingrix for adults 50 and older, including those previously vaccinated with Zostavax.
CPT 90750·VaccinesMedicare preventive
$328 – $649
16 hospitals · 25th–75th
Pneumovax 23 (PPSV23 Pneumococcal)
23-valent pneumococcal polysaccharide vaccine recommended for adults 65 and older, and earlier for those with chronic conditions.
CPT 90732·VaccinesMedicare preventive
$199 – $395
35 hospitals · 25th–75th
Prevnar 20 (PCV20 Pneumococcal Conjugate)
20-valent pneumococcal conjugate vaccine, the broader-coverage option for adults 65+ alongside or instead of PPSV23.
CPT 90671·VaccinesMedicare preventive
$256 – $428
27 hospitals · 25th–75th
Influenza Vaccine, Quadrivalent (Flu Shot)
Annual quadrivalent flu vaccine for adults. CDC recommends for everyone 6 months and older, with high-dose variants for adults 65+.
CPT 90686·VaccinesMedicare preventive
$38 – $83
34 hospitals · 25th–75th
RSV Vaccine (Abrysvo / Arexvy)
Respiratory syncytial virus vaccine, recommended as a one-time dose for adults 60 and older to reduce risk of severe lower-respiratory illness.
CPT 90679·VaccinesMedicare preventive
$386 – $498
2 hospitals · 25th–75th
Tdap Booster (Tetanus, Diphtheria, Pertussis)
Combined tetanus, diphtheria, and pertussis booster. Recommended every 10 years for adults, with at least one Tdap-containing dose in adulthood.
CPT 90715·Vaccines
$69 – $174
36 hospitals · 25th–75th
Screening Mammography (Bilateral)
Annual or biennial screening mammogram for breast cancer detection. Recommended for women starting at 40-50 depending on guideline body, continuing through age 74.
CPT 77067·Cancer ScreeningCMS shoppableMedicare preventive
$137 – $267
37 hospitals · 25th–75th
Diagnostic Mammography (Unilateral)
Targeted diagnostic mammogram of one breast, performed when a screening mammogram or symptom warrants closer evaluation.
CPT 77065·Cancer Screening
$143 – $303
36 hospitals · 25th–75th
Low-Dose CT for Lung Cancer Screening
Low-dose chest CT for adults 50-80 with significant smoking history. Annual screening reduces lung cancer mortality and is covered with no cost-sharing under Medicare and most insurers.
CPT 71271·Cancer ScreeningMedicare preventive
$224 – $598
39 hospitals · 25th–75th
Colonoscopy, Diagnostic
Diagnostic colonoscopy to examine the colon for polyps, bleeding, or other findings. Often follows an abnormal stool test or symptoms.
CPT 45378·Cancer ScreeningCMS shoppableMedicare preventive
$247 – $2,099
40 hospitals · 25th–75th
PSA (Prostate-Specific Antigen) Test
Blood test measuring prostate-specific antigen, used as an early indicator for prostate cancer in men 50+ (or earlier with risk factors).
CPT 84153·Cancer ScreeningCMS shoppableMedicare preventive
$32 – $74
37 hospitals · 25th–75th
Flexible Sigmoidoscopy
Examination of the lower colon (sigmoid) — a less-extensive alternative to full colonoscopy, sometimes paired with stool testing.
CPT 45330·Cancer ScreeningMedicare preventive
$96 – $1,592
40 hospitals · 25th–75th
Comprehensive Metabolic Panel
14-marker blood panel covering kidney function, liver function, electrolytes, and glucose. A core part of routine annual physicals.
CPT 80053·LabCMS shoppable
$18 – $122
38 hospitals · 25th–75th
Complete Blood Count (CBC) with Automated Differential
Measures red cells, white cells, platelets, and a differential of white-cell types. Screens for anemia, infection, and blood disorders.
CPT 85025·LabCMS shoppable
$10 – $46
38 hospitals · 25th–75th
Lipid Panel
Measures total cholesterol, HDL, LDL, and triglycerides. Cornerstone of cardiovascular-risk screening.
CPT 80061·LabMedicare preventive
$21 – $76
39 hospitals · 25th–75th
Hemoglobin A1c (HbA1c)
Three-month average of blood glucose. Used to diagnose diabetes/prediabetes and monitor diabetes control.
CPT 83036·LabMedicare preventive
$16 – $51
38 hospitals · 25th–75th
Thyroid-Stimulating Hormone (TSH)
First-line thyroid-function test, screening for hypothyroidism and hyperthyroidism.
CPT 84443·Lab
$25 – $107
38 hospitals · 25th–75th
Vitamin D, 25-Hydroxy
Measures circulating vitamin D, increasingly tested in adults 50+ for bone-health and general-wellness reasons.
CPT 82306·Lab
$51 – $118
38 hospitals · 25th–75th
Urinalysis, Automated, Without Microscopy
Routine automated dipstick urinalysis used to screen for kidney issues, infection, and diabetes-related changes.
CPT 81003·Lab
$4 – $48
38 hospitals · 25th–75th
BNP (Natriuretic Peptide)
Blood biomarker for heart failure. Used in emergency departments to evaluate shortness of breath and in ongoing heart-failure management.
CPT 83880·Lab
$61 – $195
38 hospitals · 25th–75th
MRI of the Knee, Without Contrast
MRI of the knee without injected dye, used to evaluate joint pain, ligament tears, meniscal injury, and other soft-tissue conditions.
CPT 73721·Imaging
$611 – $2,747
39 hospitals · 25th–75th
MRI of the Brain, With and Without Contrast
Brain MRI with and without injected gadolinium contrast. Used to evaluate stroke, tumour, multiple sclerosis, and other neurological conditions.
CPT 70553·Imaging
$662 – $3,524
39 hospitals · 25th–75th
MRI of the Lumbar Spine, Without Contrast
MRI of the lower back to evaluate disc herniation, stenosis, and nerve compression — a frequent imaging study in adults with chronic back pain.
CPT 72148·Imaging
$595 – $2,689
39 hospitals · 25th–75th
MRI of the Shoulder, Without Contrast
Shoulder MRI used to evaluate rotator cuff tears, labral injuries, and chronic shoulder pain.
CPT 73221·Imaging
$611 – $2,659
39 hospitals · 25th–75th
CT Scan of the Chest, Without Contrast
CT scan of the chest, used to evaluate lung nodules, persistent cough, and other chest cavity conditions.
CPT 71250·Imaging
$400 – $1,692
39 hospitals · 25th–75th
CT Abdomen and Pelvis, With Contrast
Combined CT of the abdomen and pelvis with IV contrast, used to evaluate abdominal pain, possible cancer, and many emergency presentations.
CPT 74177·ImagingCMS shoppable
$619 – $2,537
39 hospitals · 25th–75th
CT Head, Without Contrast
Non-contrast head CT, the workhorse imaging study for stroke, head injury, and acute neurological symptoms.
CPT 70450·Imaging
$383 – $1,417
39 hospitals · 25th–75th
Ultrasound of the Abdomen, Complete
Complete abdominal ultrasound to evaluate the liver, gallbladder, kidneys, pancreas, and major vessels.
CPT 76700·ImagingCMS shoppable
$254 – $1,059
39 hospitals · 25th–75th
DEXA Scan (Bone Density)
Dual-energy X-ray absorptiometry to measure bone mineral density. Recommended for women 65+ and men 70+ to screen for osteoporosis.
CPT 77080·ImagingMedicare preventive
$116 – $435
39 hospitals · 25th–75th
Chest X-Ray, Two Views
Standard two-view chest X-ray. The most common imaging study for pneumonia, congestive heart failure, and pre-operative clearance.
CPT 71046·Imaging
$110 – $414
39 hospitals · 25th–75th
Echocardiogram, Complete with Doppler
Comprehensive heart ultrasound with Doppler flow analysis. Evaluates heart-valve disease, heart failure, and structural abnormalities.
CPT 93306·Cardiology
$919 – $1,963
39 hospitals · 25th–75th
ECG, Resting 12-Lead with Interpretation
Standard resting electrocardiogram with interpretation. Used routinely to screen for arrhythmia and ischemia.
CPT 93000·Cardiology
$14 – $24
27 hospitals · 25th–75th
Cardiac Stress Test (Treadmill, with ECG)
Exercise treadmill stress test with continuous ECG monitoring. Evaluates exercise-induced symptoms and ischemia.
CPT 93015·Cardiology
$72 – $119
28 hospitals · 25th–75th
Holter Monitor (24–48 hour Continuous ECG)
Wearable continuous ECG monitor worn for 24-48 hours to capture intermittent arrhythmias not seen on a resting ECG.
CPT 93224·Cardiology
$70 – $117
27 hospitals · 25th–75th
Cardiac Catheterization, Left Heart with Coronary Angiography
Diagnostic catheterization of the left heart with coronary angiography. Performed to evaluate chest pain, possible coronary artery disease, and pre-procedure planning.
CPT 93458·Cardiology
$5,733 – $11,680
35 hospitals · 25th–75th
Upper GI Endoscopy (EGD)
Esophagogastroduodenoscopy — flexible scope of the esophagus, stomach, and upper duodenum. Used for reflux, ulcers, bleeding, and surveillance.
CPT 43235·Endoscopy
$205 – $1,911
40 hospitals · 25th–75th
Cataract Surgery, Single Eye
Removal of a cataract with insertion of an intraocular lens (IOL). One of the most common procedures in adults 65+.
CPT 66984·Outpatient SurgeryCMS shoppable
$532 – $4,445
36 hospitals · 25th–75th
Carpal Tunnel Release
Open or endoscopic release of the transverse carpal ligament to relieve median-nerve compression at the wrist.
CPT 64721·Outpatient Surgery
$468 – $3,096
39 hospitals · 25th–75th
Inguinal Hernia Repair (Open)
Open repair of an inguinal hernia in adults. Common in men 50+; performed laparoscopically as an alternative coded separately.
CPT 49505·Outpatient Surgery
$519 – $5,548
39 hospitals · 25th–75th
Skin Lesion Excision (Benign, Trunk/Arms/Legs ≤0.5 cm)
Surgical removal of a small benign skin lesion. Frequently performed in office or clinic settings, common in adults 50+ for moles and pre-cancers.
CPT 11400·Outpatient Surgery
$364 – $816
37 hospitals · 25th–75th
Major Joint Replacement of Lower Extremity Without MCC
Inpatient stay for elective hip or knee replacement without major complication or comorbidity. The most common inpatient procedure in adults 65+.
MS-DRG 470·Inpatient SurgeryCMS shoppable
$19,392 – $28,177
42 hospitals · 25th–75th
Heart Failure & Shock With Major Complication
Inpatient admission for decompensated heart failure with major complication or comorbidity — one of the most common Medicare admissions.
MS-DRG 291·Inpatient Medicine
$12,907 – $18,753
42 hospitals · 25th–75th
Septicemia or Severe Sepsis Without Mechanical Ventilation 96+ Hours, with MCC
Inpatient admission for septicemia or severe sepsis (without prolonged ventilation), with major complication. A leading admission code by volume.
MS-DRG 871·Inpatient Medicine
$17,442 – $27,951
43 hospitals · 25th–75th
Chronic Obstructive Pulmonary Disease With MCC
Inpatient admission for COPD exacerbation with major complication or comorbidity — common in adults 65+ with smoking history.
MS-DRG 190·Inpatient Medicine
$10,872 – $16,921
43 hospitals · 25th–75th
Emergency Department Visit, Moderate Severity
Emergency department evaluation and management of moderate severity (Level 4). The most-common ED level for adults with significant non-life-threatening symptoms.
CPT 99284·Emergency
$1,423 – $3,071
38 hospitals · 25th–75th
Emergency Department Visit, High Severity
Emergency department evaluation and management of high severity (Level 5). For complex or unstable presentations.
CPT 99285·Emergency
$2,421 – $5,984
38 hospitals · 25th–75th
Physical Therapy Evaluation, Low Complexity
Initial physical therapy evaluation, low complexity. Frequently the entry point for outpatient PT after orthopedic surgery, falls, or chronic pain.
CPT 97161·Therapy
$127 – $261
38 hospitals · 25th–75th
Psychiatric Diagnostic Evaluation
Comprehensive initial psychiatric evaluation by a licensed mental-health clinician. Covers diagnostic interview without medical services.
CPT 90791·Mental Health
$168 – $503
34 hospitals · 25th–75th
Comprehensive Eye Exam, Established Patient
Comprehensive ophthalmologic exam for an established patient, including refraction. Recommended every 1-2 years for adults 50+ to screen for cataracts and glaucoma.
CPT 92014·Vision
$74 – $212
33 hospitals · 25th–75th
Polysomnography (Attended Sleep Study, 4+ Channels)
Attended overnight sleep study to diagnose sleep apnea and other sleep disorders. Common diagnostic step before CPAP therapy.
CPT 95810·Sleep
$1,422 – $3,399
32 hospitals · 25th–75th