| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $14 | $22 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $8 | $10 |
| Immunization admin injection single CPT 90471 • Preventive Care | $5 | $10 | $15 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $9 | $9 | $10 |
| 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 | $104 | $114 | $123 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $20 | $22 | $24 |
| MMR vaccine CPT 90707 • Preventive Care | $21 | $79 | $117 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $39 | $49 | $59 |
| Varicella vaccine CPT 90716 • Preventive Care | $195 | $213 | $230 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $133 | $137 | $141 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $219 | $250 | $282 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $84 | $101 | $109 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $90 | $102 | $113 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $56 | $87 | $118 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $64 | $97 | $133 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $95 | $112 | $128 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $78 | $78 | $78 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $121 | $141 | $161 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $63 | $64 | $64 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $36 | $52 | $71 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $49 | $60 | $71 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $77 | $95 | $113 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $78 | $80 | $83 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $85 | $104 | $122 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $14 | $80 | $132 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $30 | $37 | $43 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $60 | $90 | $119 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $20 | $189 | $359 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $195 | $277 | $359 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $77 | $145 | $179 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $143 | $161 | $178 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $96 | $112 | $127 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $302 | $304 | $308 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $335 | $337 | $339 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $315 | $315 | $315 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $158 | $293 | $428 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $393 | $393 | $393 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $223 | $906 | $1,589 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $63 | $74 | $84 |
| Spirometry CPT 94010 • Pulmonology | $7 | $20 | $27 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $34 | $36 | $38 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $47 | $54 | $60 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $12 | $12 | $12 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $62 | $110 | $151 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $10 | $10 | $10 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $11 | $14 | $17 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $40 | $50 | $55 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $11 | $28 | $44 |