| Immunization admin each additional component CPT 90461 • Preventive Care | $12 | $12 | $12 |
| Immunization admin injection single CPT 90471 • Preventive Care | $16 | $16 | $16 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $12 | $12 | $12 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $336 | $352 | $369 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $231 | $242 | $254 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $105 | $110 | $115 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $5 | $13 | $20 |
| MMR vaccine CPT 90707 • Preventive Care | $100 | $103 | $107 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $40 | $47 | $55 |
| Varicella vaccine CPT 90716 • Preventive Care | $196 | $206 | $215 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $131 | $132 | $133 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $220 | $231 | $241 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $5 | $5 | $5 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $5 | $5 | $5 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $108 | $108 | $108 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $5 | $5 | $5 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $166 | $166 | $166 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $150 | $150 | $150 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $207 | $207 | $207 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $88 | $88 | $88 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $5 | $5 | $5 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $5 | $5 | $5 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $5 | $5 | $5 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $5 | $5 | $5 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $5 | $5 | $5 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $5 | $5 | $5 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $35 | $35 | $35 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $165 | $165 | $165 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $301 | $301 | $301 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $302 | $302 | $302 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $148 | $148 | $148 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $148 | $148 | $148 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $116 | $116 | $116 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $316 | $316 | $316 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $355 | $355 | $355 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $328 | $328 | $328 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $199 | $199 | $199 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $224 | $224 | $224 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $1,662 | $1,662 | $1,662 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $118 | $118 | $118 |
| Spirometry CPT 94010 • Pulmonology | $23 | $23 | $23 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $35 | $35 | $35 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $42 | $42 | $42 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $48 | $48 | $48 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $88 | $88 | $88 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $14 | $14 | $14 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $21 | $21 | $21 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $53 | $53 | $53 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $39 | $39 | $39 |
| Diffusing capacity (DLCO) CPT 94729 • Pulmonology | $11 | $11 | $11 |