| Immunization admin first vaccine component CPT 90460 • Preventive Care | $5 | $12 | $20 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $8 | $12 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $15 | $20 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $13 | $13 | $13 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $329 | $332 | $335 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $230 | $244 | $258 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $115 | $115 | $115 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $19 | $19 | $19 |
| MMR vaccine CPT 90707 • Preventive Care | $21 | $51 | $82 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $47 | $47 | $47 |
| Varicella vaccine CPT 90716 • Preventive Care | $217 | $217 | $217 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $117 | $125 | $133 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $183 | $201 | $219 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $79 | $84 | $88 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $92 | $92 | $92 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $168 | $168 | $168 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $107 | $118 | $127 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $108 | $108 | $108 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $134 | $138 | $142 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $131 | $131 | $131 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $55 | $77 | $98 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $12 | $76 | $147 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $71 | $83 | $95 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $95 | $95 | $95 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $74 | $74 | $74 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $104 | $104 | $104 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $44 | $78 | $106 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $55 | $55 | $55 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $46 | $117 | $188 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $29 | $150 | $272 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $241 | $257 | $272 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $106 | $121 | $131 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $130 | $134 | $138 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $97 | $101 | $106 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $45 | $122 | $199 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $221 | $221 | $221 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $351 | $351 | $351 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $278 | $278 | $278 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $510 | $510 | $510 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $993 | $1,289 | $1,584 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $96 | $98 | $100 |
| Spirometry CPT 94010 • Pulmonology | $7 | $17 | $28 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $23 | $23 | $23 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $65 | $65 | $65 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $20 | $20 | $20 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $72 | $128 | $184 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $24 | $24 | $24 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $23 | $23 | $23 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $13 | $28 | $42 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $11 | $24 | $45 |