| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $11 | $14 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $9 | $13 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $11 | $13 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $11 | $11 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $340 | $367 | $395 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $267 | $269 | $272 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $105 | $114 | $123 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $24 | $24 | $25 |
| MMR vaccine CPT 90707 • Preventive Care | $100 | $110 | $117 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $51 | $55 | $58 |
| Varicella vaccine CPT 90716 • Preventive Care | $198 | $214 | $230 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $132 | $136 | $141 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $205 | $232 | $259 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $85 | $116 | $178 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $89 | $97 | $105 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $92 | $117 | $141 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $77 | $93 | $124 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $101 | $111 | $120 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $90 | $104 | $117 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $127 | $139 | $151 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $53 | $59 | $65 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $59 | $74 | $82 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $59 | $70 | $81 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $89 | $97 | $106 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $67 | $79 | $91 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $97 | $151 | $205 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $95 | $102 | $105 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $32 | $34 | $36 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $44 | $44 | $44 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $74 | $159 | $255 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $148 | $343 | $538 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $97 | $123 | $137 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $137 | $205 | $273 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $107 | $146 | $185 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $187 | $233 | $256 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $124 | $207 | $289 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $133 | $271 | $408 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $265 | $317 | $369 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $327 | $360 | $393 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $964 | $1,173 | $1,381 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $86 | $86 | $86 |
| Spirometry CPT 94010 • Pulmonology | $21 | $33 | $57 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $30 | $33 | $35 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $22 | $35 | $47 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $29 | $32 | $34 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $67 | $100 | $119 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $9 | $12 | $15 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $13 | $14 | $14 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $41 | $42 | $42 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $9 | $14 | $25 |