| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $10 | $10 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $5 | $5 |
| Immunization admin injection single CPT 90471 • Preventive Care | $3 | $10 | $17 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $2 | $5 | $9 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $336 | $336 | $336 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $230 | $230 | $231 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $52 | $78 | $104 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $10 | $15 | $20 |
| MMR vaccine CPT 90707 • Preventive Care | $100 | $102 | $103 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $39 | $39 | $39 |
| Varicella vaccine CPT 90716 • Preventive Care | $195 | $195 | $196 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $20 | $77 | $133 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $36 | $127 | $219 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $62 | $79 | $97 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $7 | $56 | $105 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $35 | $84 | $113 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $12 | $84 | $127 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $11 | $83 | $123 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $10 | $95 | $142 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $22 | $83 | $145 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $5 | $5 | $5 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $31 | $60 | $89 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $9 | $9 | $9 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $7 | $7 | $7 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $7 | $53 | $98 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $107 | $107 | $107 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $9 | $48 | $88 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $5 | $20 | $34 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $19 | $74 | $128 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $30 | $116 | $202 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $20 | $74 | $128 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $91 | $91 | $92 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $158 | $158 | $158 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $106 | $106 | $106 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $55 | $164 | $273 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $150 | $224 | $299 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $25 | $25 | $25 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $45 | $171 | $297 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $24 | $93 | $161 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $31 | $435 | $839 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $93 | $93 | $93 |
| Spirometry CPT 94010 • Pulmonology | $8 | $23 | $38 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $15 | $41 | $67 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $68 | $68 | $68 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $33 | $33 | $34 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $34 | $109 | $184 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $16 | $24 | $33 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $18 | $18 | $18 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $31 | $46 | $61 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $13 | $30 | $48 |