| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $14 | $22 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $8 | $11 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $13 | $16 |
| 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 | $52 | $90 | $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 | $141 | $141 | $141 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $282 | $282 | $282 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $99 | $111 | $118 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $106 | $114 | $122 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $103 | $115 | $127 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $73 | $120 | $144 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $112 | $125 | $139 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $89 | $89 | $89 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $142 | $158 | $174 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $74 | $74 | $74 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $17 | $50 | $82 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $81 | $81 | $81 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $65 | $65 | $65 |
| 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 | $100 | $116 | $133 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $53 | $81 | $110 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $31 | $33 | $35 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $170 | $170 | $170 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $133 | $322 | $510 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $510 | $510 | $510 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $90 | $133 | $154 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $159 | $163 | $167 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $108 | $111 | $113 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $252 | $283 | $344 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $146 | $206 | $267 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $351 | $351 | $351 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $170 | $219 | $267 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $298 | $368 | $437 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $239 | $493 | $747 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $63 | $74 | $86 |
| Spirometry CPT 94010 • Pulmonology | $22 | $32 | $37 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $36 | $49 | $62 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $48 | $54 | $59 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $12 | $22 | $32 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $83 | $123 | $165 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $11 | $11 | $11 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $12 | $15 | $18 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $43 | $50 | $54 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $9 | $21 | $43 |