| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $11 | $13 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $8 | $12 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $11 | $12 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $11 | $12 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $312 | $353 | $395 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $245 | $258 | $272 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $102 | $113 | $123 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $21 | $22 | $24 |
| MMR vaccine CPT 90707 • Preventive Care | $92 | $108 | $117 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $50 | $54 | $58 |
| Varicella vaccine CPT 90716 • Preventive Care | $182 | $206 | $230 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $111 | $126 | $141 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $216 | $237 | $259 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $85 | $85 | $85 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $63 | $76 | $89 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $92 | $104 | $115 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $77 | $86 | $105 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $101 | $101 | $102 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $117 | $117 | $117 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $127 | $127 | $128 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $68 | $72 | $77 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $58 | $72 | $102 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $81 | $91 | $101 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $67 | $78 | $89 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $67 | $78 | $88 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $75 | $86 | $97 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $77 | $96 | $105 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $31 | $31 | $32 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $135 | $135 | $135 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $148 | $269 | $373 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $148 | $202 | $255 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $126 | $133 | $137 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $130 | $133 | $137 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $107 | $108 | $109 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $223 | $245 | $256 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $289 | $336 | $382 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $130 | $198 | $266 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $152 | $261 | $369 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $175 | $228 | $282 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $984 | $1,183 | $1,381 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $90 | $90 | $90 |
| Spirometry CPT 94010 • Pulmonology | $21 | $24 | $32 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $30 | $48 | $67 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $22 | $35 | $47 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $11 | $28 | $45 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $52 | $79 | $119 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $9 | $12 | $15 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $13 | $14 | $14 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $42 | $43 | $45 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $15 | $21 | $25 |