| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $15 | $26 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $9 | $13 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $11 | $14 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $12 | $14 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $395 | $395 | $395 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $257 | $264 | $272 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $123 | $123 | $123 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $21 | $22 | $24 |
| MMR vaccine CPT 90707 • Preventive Care | $47 | $82 | $117 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $59 | $59 | $59 |
| Varicella vaccine CPT 90716 • Preventive Care | $163 | $197 | $230 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $141 | $141 | $141 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $282 | $282 | $282 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $89 | $101 | $106 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $65 | $88 | $111 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $95 | $105 | $115 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $73 | $101 | $131 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $104 | $115 | $127 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $115 | $118 | $122 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $132 | $146 | $159 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $72 | $72 | $72 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $7 | $44 | $80 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $79 | $79 | $79 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $87 | $99 | $111 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $65 | $65 | $65 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $73 | $97 | $122 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $13 | $65 | $99 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $35 | $36 | $38 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $125 | $125 | $125 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $34 | $201 | $369 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $369 | $369 | $369 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $98 | $141 | $163 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $163 | $172 | $181 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $121 | $124 | $127 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $243 | $263 | $304 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $273 | $303 | $334 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $310 | $310 | $310 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $331 | $340 | $348 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $183 | $183 | $183 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $959 | $1,118 | $1,278 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $85 | $88 | $91 |
| Spirometry CPT 94010 • Pulmonology | $25 | $25 | $26 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $27 | $42 | $56 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $30 | $31 | $32 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $36 | $36 | $36 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $30 | $60 | $82 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $13 | $13 | $13 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $14 | $15 | $16 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $14 | $35 | $52 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $12 | $29 | $42 |