| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $10 | $10 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $7 | $9 |
| Immunization admin injection single CPT 90471 • Preventive Care | $2 | $6 | $10 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $9 | $10 | $10 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $230 | $230 | $230 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $181 | $226 | $271 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $71 | $71 | $71 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $16 | $19 | $23 |
| MMR vaccine CPT 90707 • Preventive Care | $68 | $68 | $68 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $35 | $46 | $58 |
| Varicella vaccine CPT 90716 • Preventive Care | $134 | $134 | $134 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $82 | $111 | $140 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $151 | $151 | $151 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $79 | $88 | $92 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $83 | $89 | $96 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $86 | $93 | $99 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $74 | $90 | $113 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $95 | $102 | $109 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $98 | $104 | $110 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $119 | $128 | $137 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $51 | $58 | $65 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $76 | $82 | $88 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $55 | $55 | $55 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $83 | $83 | $83 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $85 | $85 | $85 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $91 | $105 | $120 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $98 | $106 | $114 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $29 | $29 | $29 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $39 | $82 | $126 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $135 | $192 | $249 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $65 | $152 | $238 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $118 | $119 | $120 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $121 | $141 | $151 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $82 | $106 | $118 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $174 | $234 | $265 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $97 | $197 | $298 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $181 | $181 | $181 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $248 | $314 | $381 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $263 | $263 | $263 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $161 | $786 | $1,411 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $66 | $76 | $85 |
| Spirometry CPT 94010 • Pulmonology | $8 | $17 | $24 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $33 | $34 | $36 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $22 | $32 | $42 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $17 | $17 | $17 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $42 | $78 | $114 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $10 | $11 | $13 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $12 | $12 | $12 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $9 | $23 | $50 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $9 | $30 | $41 |