| Immunization admin first vaccine component CPT 90460 • Preventive Care | $20 | $20 | $20 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $10 | $10 | $10 |
| Immunization admin injection single CPT 90471 • Preventive Care | $2 | $2 | $2 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $2 | $6 | $10 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $34 | $34 | $34 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $230 | $230 | $231 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $104 | $104 | $105 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $3 | $12 | $20 |
| MMR vaccine CPT 90707 • Preventive Care | $10 | $55 | $100 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $6 | $22 | $39 |
| Varicella vaccine CPT 90716 • Preventive Care | $195 | $195 | $196 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $20 | $20 | $20 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $219 | $229 | $239 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $29 | $55 | $81 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $84 | $84 | $85 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $13 | $83 | $147 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $38 | $101 | $165 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $36 | $97 | $160 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $11 | $98 | $185 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $14 | $68 | $121 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $8 | $8 | $8 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $77 | $77 | $78 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $8 | $8 | $8 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $10 | $10 | $10 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $33 | $33 | $33 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $9 | $51 | $92 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $10 | $55 | $100 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $3 | $14 | $25 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $39 | $39 | $39 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $21 | $63 | $105 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $131 | $131 | $131 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $110 | $110 | $111 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $114 | $114 | $114 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $77 | $77 | $78 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $111 | $152 | $194 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $84 | $151 | $218 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $40 | $40 | $40 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $266 | $266 | $267 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $40 | $126 | $213 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $140 | $399 | $658 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $81 | $81 | $82 |
| Spirometry CPT 94010 • Pulmonology | $23 | $26 | $30 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $40 | $45 | $50 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $10 | $31 | $51 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $7 | $13 | $20 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $60 | $99 | $139 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $40 | $40 | $40 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $14 | $14 | $14 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $23 | $35 | $46 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $26 | $32 | $37 |