| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $15 | $22 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $8 | $12 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $15 | $25 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $11 | $12 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $316 | $346 | $395 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $272 | $288 | $304 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $99 | $114 | $123 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $19 | $22 | $24 |
| MMR vaccine CPT 90707 • Preventive Care | $94 | $107 | $114 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $34 | $50 | $59 |
| Varicella vaccine CPT 90716 • Preventive Care | $184 | $202 | $230 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $138 | $138 | $138 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $176 | $196 | $216 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $58 | $82 | $101 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $89 | $105 | $113 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $92 | $109 | $118 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $77 | $103 | $154 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $96 | $109 | $129 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $90 | $118 | $149 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $127 | $143 | $160 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $53 | $76 | $98 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $82 | $100 | $115 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $75 | $87 | $104 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $65 | $88 | $114 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $67 | $99 | $116 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $95 | $103 | $118 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $105 | $114 | $132 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $30 | $30 | $30 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $56 | $56 | $56 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $235 | $275 | $314 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $235 | $275 | $314 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $161 | $161 | $161 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $130 | $144 | $166 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $103 | $107 | $112 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $102 | $102 | $102 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $103 | $103 | $103 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $303 | $303 | $303 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $121 | $121 | $121 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $139 | $207 | $275 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $939 | $939 | $939 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $92 | $92 | $92 |
| Spirometry CPT 94010 • Pulmonology | $19 | $20 | $21 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $8 | $18 | $32 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $24 | $24 | $24 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $38 | $38 | $38 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $88 | $88 | $88 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $6 | $11 | $17 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $13 | $15 | $17 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $11 | $21 | $32 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $24 | $24 | $24 |