| Immunization admin first vaccine component CPT 90460 • Preventive Care | $9 | $10 | $10 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $6 | $7 | $8 |
| Immunization admin injection single CPT 90471 • Preventive Care | $9 | $10 | $12 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $8 | $9 | $10 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $214 | $214 | $214 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $168 | $199 | $230 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $66 | $85 | $105 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $15 | $17 | $20 |
| MMR vaccine CPT 90707 • Preventive Care | $21 | $61 | $100 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $32 | $36 | $40 |
| Varicella vaccine CPT 90716 • Preventive Care | $125 | $160 | $195 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $76 | $105 | $133 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $140 | $180 | $220 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $50 | $84 | $101 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $72 | $89 | $105 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $76 | $92 | $109 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $86 | $129 | $177 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $64 | $93 | $121 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $97 | $148 | $199 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $105 | $129 | $152 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $63 | $63 | $63 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $11 | $58 | $97 |
| 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 | $73 | $73 | $73 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $75 | $103 | $131 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $80 | $99 | $117 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $67 | $96 | $125 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $19 | $27 | $36 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $36 | $36 | $36 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $87 | $104 | $122 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $123 | $123 | $123 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $103 | $137 | $154 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $106 | $129 | $153 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $71 | $95 | $119 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $87 | $160 | $233 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $165 | $165 | $165 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $130 | $142 | $155 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $210 | $210 | $210 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $223 | $223 | $223 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $647 | $647 | $647 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $61 | $76 | $91 |
| Spirometry CPT 94010 • Pulmonology | $21 | $23 | $25 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $26 | $31 | $35 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $18 | $34 | $50 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $23 | $29 | $35 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $50 | $71 | $96 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $10 | $22 | $35 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $10 | $30 | $50 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $31 | $43 | $49 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $26 | $35 | $40 |