| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $16 | $27 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $9 | $14 |
| Immunization admin injection single CPT 90471 • Preventive Care | $5 | $12 | $20 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $12 | $12 | $12 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $395 | $395 | $395 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $230 | $251 | $272 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $1 | $1 | $1 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $24 | $24 | $24 |
| MMR vaccine CPT 90707 • Preventive Care | $1 | $5 | $10 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $59 | $59 | $59 |
| Varicella vaccine CPT 90716 • Preventive Care | $1 | $1 | $1 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $141 | $141 | $141 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $219 | $250 | $282 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $69 | $93 | $118 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $79 | $79 | $79 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $117 | $117 | $117 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $96 | $120 | $138 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $127 | $127 | $127 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $109 | $109 | $109 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $162 | $162 | $162 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $84 | $84 | $84 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $11 | $60 | $94 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $93 | $93 | $93 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $79 | $79 | $79 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $104 | $112 | $120 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $89 | $89 | $89 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $127 | $137 | $148 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $26 | $26 | $26 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $130 | $152 | $174 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $75 | $264 | $500 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $399 | $399 | $399 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $104 | $157 | $184 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $192 | $196 | $201 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $128 | $131 | $134 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $164 | $256 | $348 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $378 | $378 | $378 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $352 | $352 | $352 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $194 | $194 | $194 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $50 | $246 | $442 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $275 | $275 | $275 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $91 | $102 | $112 |
| Spirometry CPT 94010 • Pulmonology | $35 | $42 | $50 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $17 | $17 | $17 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $29 | $29 | $29 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $21 | $34 | $48 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $121 | $136 | $152 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $13 | $16 | $20 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $14 | $14 | $14 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $15 | $41 | $68 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $15 | $40 | $53 |