| Immunization admin first vaccine component CPT 90460 • Preventive Care | $11 | $16 | $24 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $8 | $10 | $12 |
| Immunization admin injection single CPT 90471 • Preventive Care | $11 | $14 | $18 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $11 | $13 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $247 | $320 | $369 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $193 | $244 | $310 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $76 | $97 | $115 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $5 | $17 | $20 |
| MMR vaccine CPT 90707 • Preventive Care | $73 | $96 | $112 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $34 | $40 | $55 |
| Varicella vaccine CPT 90716 • Preventive Care | $144 | $188 | $215 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $88 | $121 | $133 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $162 | $212 | $241 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $59 | $90 | $109 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $78 | $110 | $133 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $67 | $108 | $139 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $5 | $103 | $133 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $5 | $112 | $153 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $5 | $133 | $177 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $128 | $162 | $192 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $5 | $70 | $100 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $81 | $100 | $123 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $68 | $92 | $122 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $67 | $103 | $134 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $91 | $111 | $137 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $5 | $110 | $147 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $5 | $107 | $158 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $31 | $31 | $31 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $135 | $135 | $135 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $235 | $242 | $255 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $195 | $229 | $255 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $126 | $178 | $196 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $130 | $147 | $196 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $88 | $125 | $153 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $177 | $182 | $187 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $207 | $307 | $406 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $105 | $142 | $180 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $210 | $237 | $265 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $137 | $222 | $474 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $294 | $570 | $846 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $71 | $81 | $90 |
| Spirometry CPT 94010 • Pulmonology | $7 | $25 | $36 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $32 | $35 | $39 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $27 | $36 | $45 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $30 | $33 | $37 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $54 | $66 | $78 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $6 | $10 | $14 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $13 | $14 | $16 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $11 | $28 | $46 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $24 | $36 | $48 |