| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $14 | $22 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $8 | $10 |
| Immunization admin injection single CPT 90471 • Preventive Care | $8 | $14 | $21 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $12 | $14 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $335 | $365 | $395 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $230 | $251 | $272 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $104 | $114 | $123 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $20 | $22 | $24 |
| MMR vaccine CPT 90707 • Preventive Care | $62 | $90 | $117 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $53 | $56 | $59 |
| Varicella vaccine CPT 90716 • Preventive Care | $107 | $169 | $230 |
| 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 | $49 | $81 | $113 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $83 | $104 | $124 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $55 | $85 | $115 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $62 | $98 | $134 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $90 | $108 | $127 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $105 | $109 | $114 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $84 | $128 | $171 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $42 | $42 | $42 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $49 | $49 | $49 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $71 | $71 | $71 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $55 | $69 | $82 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $78 | $86 | $94 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $85 | $89 | $93 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $95 | $115 | $137 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $29 | $34 | $39 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $124 | $124 | $124 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $28 | $111 | $194 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $171 | $266 | $361 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $78 | $129 | $168 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $144 | $156 | $167 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $97 | $114 | $130 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $291 | $293 | $295 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $319 | $319 | $319 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $132 | $218 | $303 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $317 | $317 | $317 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $171 | $171 | $171 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $933 | $933 | $933 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $70 | $82 | $94 |
| Spirometry CPT 94010 • Pulmonology | $7 | $20 | $27 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $12 | $39 | $65 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $28 | $45 | $61 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $32 | $32 | $32 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $82 | $118 | $154 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $9 | $10 | $12 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $13 | $13 | $13 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $40 | $49 | $54 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $40 | $42 | $44 |