| Immunization admin each additional component CPT 90461 • Preventive Care | $11 | $11 | $11 |
| Immunization admin injection single CPT 90471 • Preventive Care | $12 | $12 | $12 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $11 | $11 | $11 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $329 | $329 | $329 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $258 | $258 | $258 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $102 | $102 | $102 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $22 | $22 | $22 |
| MMR vaccine CPT 90707 • Preventive Care | $58 | $58 | $58 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $50 | $50 | $50 |
| Varicella vaccine CPT 90716 • Preventive Care | $115 | $115 | $115 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $70 | $70 | $70 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $129 | $129 | $129 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $68 | $68 | $68 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $108 | $108 | $108 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $112 | $112 | $112 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $126 | $126 | $126 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $95 | $95 | $95 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $112 | $112 | $112 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $120 | $120 | $120 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $61 | $78 | $95 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $98 | $98 | $98 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $65 | $65 | $65 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $107 | $107 | $107 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $83 | $83 | $83 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $78 | $99 | $120 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $84 | $84 | $84 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $24 | $24 | $24 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $134 | $134 | $134 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $204 | $204 | $204 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $116 | $116 | $116 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $119 | $119 | $119 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $122 | $141 | $151 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $83 | $106 | $118 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $88 | $88 | $88 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $166 | $166 | $166 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $90 | $90 | $90 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $323 | $323 | $323 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $183 | $183 | $183 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $677 | $677 | $677 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $89 | $89 | $89 |
| Spirometry CPT 94010 • Pulmonology | $22 | $22 | $22 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $36 | $36 | $36 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $28 | $28 | $28 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $10 | $10 | $10 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $103 | $103 | $103 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $16 | $16 | $16 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $16 | $16 | $16 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $8 | $8 | $8 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $8 | $8 | $8 |
| Diffusing capacity (DLCO) CPT 94729 • Pulmonology | $30 | $30 | $30 |