| Immunization admin each additional component CPT 90461 • Preventive Care | $12 | $12 | $12 |
| Immunization admin injection single CPT 90471 • Preventive Care | $24 | $24 | $24 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $12 | $12 | $12 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $329 | $329 | $329 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $258 | $258 | $258 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $102 | $102 | $102 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $22 | $22 | $22 |
| MMR vaccine CPT 90707 • Preventive Care | $97 | $97 | $97 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $50 | $50 | $50 |
| Varicella vaccine CPT 90716 • Preventive Care | $192 | $192 | $192 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $117 | $117 | $117 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $216 | $216 | $216 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $63 | $63 | $63 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $94 | $94 | $94 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $98 | $98 | $98 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $84 | $84 | $84 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $81 | $81 | $81 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $98 | $98 | $98 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $135 | $135 | $135 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $58 | $58 | $58 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $63 | $63 | $63 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $86 | $86 | $86 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $94 | $94 | $94 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $96 | $96 | $96 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $103 | $103 | $103 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $84 | $84 | $84 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $23 | $23 | $23 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $47 | $47 | $47 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $254 | $254 | $254 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $155 | $155 | $155 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $136 | $136 | $136 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $140 | $140 | $140 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $94 | $94 | $94 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $110 | $110 | $110 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $220 | $220 | $220 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $113 | $113 | $113 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $269 | $269 | $269 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $286 | $286 | $286 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $186 | $186 | $186 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $77 | $77 | $77 |
| Spirometry CPT 94010 • Pulmonology | $7 | $7 | $7 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $11 | $11 | $11 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $49 | $49 | $49 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $32 | $32 | $32 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $58 | $58 | $58 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $14 | $14 | $14 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $14 | $14 | $14 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $42 | $42 | $42 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $34 | $34 | $34 |
| Diffusing capacity (DLCO) CPT 94729 • Pulmonology | $8 | $8 | $8 |