| Immunization admin each additional component CPT 90461 • Preventive Care | $12 | $12 | $12 |
| Immunization admin injection single CPT 90471 • Preventive Care | $14 | $14 | $14 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $14 | $14 | $14 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $395 | $395 | $395 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $272 | $272 | $272 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $123 | $123 | $123 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $24 | $24 | $24 |
| MMR vaccine CPT 90707 • Preventive Care | $117 | $117 | $117 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $59 | $59 | $59 |
| Varicella vaccine CPT 90716 • Preventive Care | $230 | $230 | $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 | $85 | $85 | $85 |
| 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 | $91 | $91 | $91 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $99 | $99 | $99 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $69 | $69 | $69 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $116 | $116 | $116 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $93 | $93 | $93 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $67 | $67 | $67 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $76 | $76 | $76 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $54 | $54 | $54 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $61 | $61 | $61 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $62 | $62 | $62 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $92 | $92 | $92 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $100 | $100 | $100 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $33 | $33 | $33 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $119 | $119 | $119 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $351 | $351 | $351 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $351 | $351 | $351 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $93 | $93 | $93 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $163 | $163 | $163 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $109 | $109 | $109 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $352 | $352 | $352 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $164 | $164 | $164 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $295 | $295 | $295 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $383 | $383 | $383 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $214 | $214 | $214 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $246 | $246 | $246 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $81 | $81 | $81 |
| Spirometry CPT 94010 • Pulmonology | $7 | $7 | $7 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $40 | $40 | $40 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $55 | $55 | $55 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $14 | $14 | $14 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $134 | $134 | $134 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $11 | $11 | $11 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $14 | $14 | $14 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $56 | $56 | $56 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $13 | $13 | $13 |
| Diffusing capacity (DLCO) CPT 94729 • Pulmonology | $9 | $9 | $9 |