| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $11 | $14 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $9 | $13 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $12 | $14 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $11 | $13 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $371 | $383 | $395 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $272 | $282 | $292 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $115 | $119 | $123 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $24 | $24 | $25 |
| MMR vaccine CPT 90707 • Preventive Care | $9 | $72 | $114 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $56 | $57 | $58 |
| Varicella vaccine CPT 90716 • Preventive Care | $217 | $224 | $230 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $132 | $136 | $141 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $244 | $244 | $244 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $85 | $85 | $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 | $92 | $92 | $93 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $77 | $104 | $131 |
| 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 | $247 | $247 | $247 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $127 | $198 | $269 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $66 | $66 | $66 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $74 | $123 | $172 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $59 | $59 | $59 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $111 | $126 | $141 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $91 | $91 | $91 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $97 | $97 | $97 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $132 | $176 | $221 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $32 | $48 | $64 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $53 | $53 | $53 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $74 | $109 | $145 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $144 | $145 | $145 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $126 | $133 | $137 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $163 | $218 | $273 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $107 | $117 | $127 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $187 | $233 | $256 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $253 | $271 | $289 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $221 | $221 | $221 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $265 | $317 | $369 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $343 | $343 | $343 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $173 | $777 | $1,381 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $91 | $120 | $150 |
| Spirometry CPT 94010 • Pulmonology | $8 | $16 | $21 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $30 | $36 | $43 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $45 | $46 | $47 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $18 | $18 | $18 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $68 | $112 | $150 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $28 | $28 | $28 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $16 | $16 | $16 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $31 | $38 | $42 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $25 | $33 | $42 |