| 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 | $14 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $11 | $13 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $371 | $383 | $395 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $272 | $282 | $292 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $115 | $119 | $123 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $24 | $24 | $25 |
| MMR vaccine CPT 90707 • Preventive Care | $109 | $113 | $117 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $56 | $57 | $58 |
| Varicella vaccine CPT 90716 • Preventive Care | $217 | $224 | $230 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $132 | $136 | $141 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $244 | $251 | $259 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $85 | $98 | $125 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $89 | $99 | $108 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $92 | $99 | $105 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $77 | $91 | $119 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $86 | $94 | $101 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $90 | $111 | $133 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $127 | $136 | $145 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $53 | $73 | $93 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $58 | $72 | $99 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $58 | $114 | $171 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $65 | $74 | $82 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $84 | $88 | $91 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $97 | $108 | $119 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $77 | $84 | $97 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $32 | $33 | $35 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $49 | $49 | $49 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $144 | $201 | $311 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $164 | $226 | $288 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $137 | $143 | $154 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $137 | $142 | $147 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $100 | $103 | $107 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $116 | $209 | $256 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $235 | $262 | $289 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $119 | $192 | $266 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $301 | $335 | $369 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $175 | $232 | $288 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $959 | $1,170 | $1,381 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $150 | $150 | $150 |
| Spirometry CPT 94010 • Pulmonology | $14 | $18 | $21 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $30 | $52 | $74 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $27 | $37 | $47 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $21 | $25 | $29 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $67 | $109 | $143 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $9 | $19 | $28 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $13 | $14 | $16 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $42 | $43 | $46 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $9 | $28 | $50 |