| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $11 | $14 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $9 | $13 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $10 | $11 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $11 | $15 | $18 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $395 | $395 | $395 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $230 | $251 | $272 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $102 | $103 | $104 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $20 | $22 | $24 |
| MMR vaccine CPT 90707 • Preventive Care | $97 | $100 | $103 |
| 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 | $141 | $141 | $141 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $282 | $282 | $282 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $62 | $93 | $109 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $115 | $139 | $164 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $98 | $105 | $113 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $105 | $147 | $193 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $78 | $88 | $98 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $216 | $216 | $216 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $99 | $111 | $123 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $33 | $49 | $65 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $67 | $86 | $105 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $68 | $77 | $86 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $70 | $70 | $70 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $92 | $98 | $104 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $103 | $111 | $120 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $14 | $67 | $119 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $23 | $27 | $31 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $128 | $128 | $128 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $98 | $174 | $251 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $318 | $318 | $318 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $100 | $127 | $154 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $125 | $142 | $151 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $100 | $112 | $118 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $115 | $229 | $318 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $282 | $313 | $345 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $117 | $117 | $117 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $138 | $276 | $413 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $275 | $275 | $275 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $823 | $885 | $947 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $61 | $71 | $80 |
| Spirometry CPT 94010 • Pulmonology | $19 | $26 | $32 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $32 | $43 | $54 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $44 | $48 | $52 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $19 | $19 | $19 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $30 | $83 | $143 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $14 | $14 | $14 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $24 | $24 | $24 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $10 | $37 | $54 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $9 | $24 | $44 |