| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $10 | $10 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $6 | $9 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $10 | $10 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $9 | $10 | $10 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $230 | $259 | $274 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $181 | $232 | $257 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $71 | $85 | $92 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $16 | $19 | $21 |
| MMR vaccine CPT 90707 • Preventive Care | $68 | $85 | $93 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $35 | $36 | $37 |
| Varicella vaccine CPT 90716 • Preventive Care | $134 | $153 | $163 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $82 | $116 | $133 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $151 | $169 | $187 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $79 | $99 | $106 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $59 | $94 | $111 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $86 | $105 | $115 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $98 | $123 | $131 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $95 | $116 | $127 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $110 | $135 | $147 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $119 | $146 | $159 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $71 | $84 | $96 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $76 | $89 | $102 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $76 | $88 | $101 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $63 | $87 | $111 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $85 | $104 | $114 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $91 | $112 | $122 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $98 | $115 | $132 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $20 | $32 | $38 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $41 | $136 | $183 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $34 | $203 | $338 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $135 | $237 | $338 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $118 | $152 | $163 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $121 | $149 | $163 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $82 | $112 | $127 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $96 | $206 | $243 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $194 | $247 | $273 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $181 | $216 | $252 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $248 | $315 | $348 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $263 | $317 | $371 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $161 | $906 | $1,278 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $66 | $83 | $91 |
| Spirometry CPT 94010 • Pulmonology | $19 | $24 | $26 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $9 | $28 | $37 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $20 | $46 | $59 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $28 | $32 | $36 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $114 | $138 | $150 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $10 | $11 | $13 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $12 | $19 | $30 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $38 | $49 | $52 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $30 | $36 | $42 |