| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $11 | $12 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $7 | $11 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $11 | $12 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $10 | $11 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $296 | $362 | $395 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $245 | $263 | $272 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $97 | $114 | $123 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $21 | $23 | $24 |
| MMR vaccine CPT 90707 • Preventive Care | $87 | $106 | $117 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $45 | $54 | $60 |
| Varicella vaccine CPT 90716 • Preventive Care | $173 | $211 | $230 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $105 | $129 | $141 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $194 | $245 | $282 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $58 | $73 | $85 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $89 | $89 | $89 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $65 | $81 | $92 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $77 | $78 | $79 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $101 | $139 | $214 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $90 | $151 | $247 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $96 | $117 | $128 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $53 | $97 | $161 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $58 | $58 | $59 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $58 | $65 | $81 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $65 | $81 | $112 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $67 | $109 | $193 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $73 | $89 | $97 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $77 | $134 | $221 |
| 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 | $74 | $251 | $536 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $144 | $171 | $220 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $124 | $132 | $137 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $137 | $145 | $162 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $107 | $133 | $185 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $256 | $285 | $345 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $103 | $227 | $289 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $266 | $313 | $408 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $156 | $263 | $369 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $175 | $283 | $393 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $333 | $1,032 | $1,381 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $71 | $71 | $71 |
| Spirometry CPT 94010 • Pulmonology | $14 | $16 | $21 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $30 | $45 | $74 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $45 | $47 | $47 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $19 | $37 | $63 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $68 | $102 | $119 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $9 | $15 | $28 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $13 | $18 | $27 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $33 | $54 | $86 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $9 | $16 | $25 |