| Immunization admin first vaccine component CPT 90460 • Preventive Care | $12 | $17 | $20 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $10 | $10 | $11 |
| Immunization admin injection single CPT 90471 • Preventive Care | $4 | $8 | $12 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $10 | $11 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $329 | $329 | $329 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $230 | $244 | $258 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $102 | $103 | $104 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $20 | $21 | $22 |
| MMR vaccine CPT 90707 • Preventive Care | $10 | $69 | $100 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $39 | $44 | $50 |
| Varicella vaccine CPT 90716 • Preventive Care | $192 | $193 | $195 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $117 | $117 | $117 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $216 | $216 | $216 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $81 | $85 | $91 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $84 | $90 | $96 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $74 | $81 | $88 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $100 | $107 | $114 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $96 | $103 | $110 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $128 | $128 | $128 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $110 | $115 | $121 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $83 | $83 | $83 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $39 | $60 | $77 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $65 | $65 | $65 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $74 | $74 | $74 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $66 | $83 | $99 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $92 | $99 | $106 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $10 | $75 | $114 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $25 | $29 | $33 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $39 | $43 | $48 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $160 | $186 | $212 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $275 | $275 | $275 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $110 | $119 | $136 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $114 | $127 | $140 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $77 | $86 | $95 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $194 | $196 | $201 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $114 | $166 | $218 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $113 | $160 | $208 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $266 | $274 | $283 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $40 | $170 | $300 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $191 | $424 | $658 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $79 | $80 | $81 |
| Spirometry CPT 94010 • Pulmonology | $21 | $27 | $30 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $48 | $49 | $50 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $24 | $38 | $51 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $19 | $19 | $19 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $71 | $96 | $139 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $14 | $15 | $15 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $13 | $27 | $40 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $43 | $45 | $46 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $25 | $33 | $37 |