| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $17 | $24 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $9 | $12 |
| Immunization admin injection single CPT 90471 • Preventive Care | $8 | $15 | $24 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $12 | $13 | $16 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $329 | $329 | $329 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $230 | $240 | $258 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $42 | $62 | $102 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $22 | $22 | $22 |
| MMR vaccine CPT 90707 • Preventive Care | $35 | $56 | $97 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $50 | $50 | $50 |
| Varicella vaccine CPT 90716 • Preventive Care | $39 | $94 | $192 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $25 | $56 | $117 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $24 | $120 | $216 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $55 | $73 | $109 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $55 | $75 | $114 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $60 | $80 | $119 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $70 | $108 | $134 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $98 | $104 | $110 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $125 | $134 | $151 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $78 | $121 | $163 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $81 | $89 | $98 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $27 | $64 | $88 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $50 | $83 | $122 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $60 | $103 | $134 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $105 | $111 | $117 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $115 | $118 | $125 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $66 | $89 | $134 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $6 | $22 | $38 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $151 | $157 | $162 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $74 | $240 | $371 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $74 | $135 | $195 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $127 | $133 | $136 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $135 | $147 | $169 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $106 | $109 | $114 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $276 | $288 | $300 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $149 | $149 | $149 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $73 | $221 | $309 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $380 | $385 | $390 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $19 | $215 | $411 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $883 | $1,096 | $1,309 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $83 | $88 | $94 |
| Spirometry CPT 94010 • Pulmonology | $9 | $17 | $25 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $36 | $47 | $59 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $59 | $59 | $59 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $15 | $29 | $36 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $90 | $90 | $90 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $18 | $24 | $30 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $16 | $16 | $17 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $51 | $51 | $52 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $41 | $41 | $41 |