| Immunization admin each additional component CPT 90461 • Preventive Care | $11 | $11 | $11 |
| Immunization admin injection single CPT 90471 • Preventive Care | $18 | $18 | $18 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $8 | $8 | $8 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $395 | $395 | $395 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $272 | $272 | $272 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $123 | $123 | $123 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $24 | $24 | $24 |
| MMR vaccine CPT 90707 • Preventive Care | $117 | $117 | $117 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $59 | $59 | $59 |
| Varicella vaccine CPT 90716 • Preventive Care | $230 | $230 | $230 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $141 | $141 | $141 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $282 | $282 | $282 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $50 | $50 | $50 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $85 | $85 | $85 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $57 | $57 | $57 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $91 | $91 | $91 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $64 | $64 | $64 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $107 | $107 | $107 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $86 | $86 | $86 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $63 | $63 | $63 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $50 | $50 | $50 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $50 | $50 | $50 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $77 | $77 | $77 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $77 | $77 | $77 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $85 | $85 | $85 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $95 | $95 | $95 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $31 | $31 | $31 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $110 | $110 | $110 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $180 | $180 | $180 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $180 | $180 | $180 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $87 | $87 | $87 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $160 | $160 | $160 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $105 | $105 | $105 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $268 | $268 | $268 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $125 | $125 | $125 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $125 | $125 | $125 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $146 | $146 | $146 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $349 | $349 | $349 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $844 | $844 | $844 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $76 | $76 | $76 |
| Spirometry CPT 94010 • Pulmonology | $7 | $7 | $7 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $51 | $51 | $51 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $25 | $25 | $25 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $20 | $20 | $20 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $77 | $77 | $77 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $12 | $12 | $12 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $14 | $14 | $14 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $52 | $52 | $52 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $28 | $28 | $28 |
| Diffusing capacity (DLCO) CPT 94729 • Pulmonology | $43 | $43 | $43 |