| Immunization admin each additional component CPT 90461 • Preventive Care | $11 | $11 | $11 |
| Immunization admin injection single CPT 90471 • Preventive Care | $8 | $13 | $22 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $11 | $14 | $16 |
| 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 | $42 | $69 | $123 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $24 | $24 | $24 |
| MMR vaccine CPT 90707 • Preventive Care | $35 | $62 | $117 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $40 | $50 | $59 |
| Varicella vaccine CPT 90716 • Preventive Care | $50 | $110 | $230 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $25 | $64 | $141 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $282 | $282 | $282 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $55 | $64 | $83 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $55 | $66 | $89 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $60 | $69 | $87 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $70 | $78 | $95 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $95 | $102 | $110 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $112 | $121 | $125 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $78 | $100 | $121 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $45 | $54 | $63 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $50 | $57 | $71 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $50 | $57 | $70 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $60 | $66 | $77 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $78 | $91 | $105 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $86 | $105 | $115 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $66 | $76 | $95 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $31 | $31 | $31 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $150 | $150 | $150 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $463 | $463 | $463 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $463 | $463 | $463 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $78 | $78 | $78 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $130 | $137 | $144 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $95 | $95 | $95 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $257 | $257 | $257 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $281 | $281 | $281 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $262 | $262 | $262 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $280 | $280 | $280 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $329 | $329 | $329 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $760 | $760 | $760 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $71 | $71 | $71 |
| Spirometry CPT 94010 • Pulmonology | $7 | $7 | $7 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $13 | $13 | $13 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $23 | $23 | $23 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $16 | $16 | $16 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $119 | $119 | $119 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $10 | $18 | $26 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $11 | $11 | $11 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $37 | $37 | $37 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $27 | $27 | $27 |
| Diffusing capacity (DLCO) CPT 94729 • Pulmonology | $48 | $48 | $48 |