| Immunization admin first vaccine component CPT 90460 • Preventive Care | $10 | $14 | $21 |
| Immunization admin each additional component CPT 90461 • Preventive Care | $5 | $6 | $8 |
| Immunization admin injection single CPT 90471 • Preventive Care | $17 | $19 | $23 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $9 | $10 | $12 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $329 | $329 | $329 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $230 | $244 | $258 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $102 | $103 | $104 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $20 | $21 | $22 |
| MMR vaccine CPT 90707 • Preventive Care | $97 | $98 | $100 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $39 | $44 | $50 |
| Varicella vaccine CPT 90716 • Preventive Care | $192 | $193 | $195 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $117 | $125 | $133 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $216 | $216 | $216 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $81 | $92 | $97 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $89 | $97 | $105 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $88 | $96 | $104 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $95 | $107 | $114 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $106 | $110 | $113 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $116 | $116 | $116 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $124 | $135 | $145 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $57 | $57 | $57 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $66 | $78 | $89 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $69 | $79 | $89 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $76 | $87 | $98 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $85 | $92 | $98 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $89 | $98 | $107 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $97 | $109 | $121 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $34 | $34 | $34 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $33 | $33 | $33 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $238 | $307 | $375 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $58 | $80 | $102 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $91 | $92 | $92 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $142 | $150 | $158 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $106 | $109 | $112 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $91 | $212 | $273 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $233 | $266 | $299 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $91 | $91 | $91 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $106 | $201 | $297 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $314 | $336 | $358 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $149 | $494 | $839 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $72 | $83 | $93 |
| Spirometry CPT 94010 • Pulmonology | $26 | $34 | $38 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $38 | $52 | $67 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $60 | $64 | $68 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $36 | $36 | $36 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $57 | $121 | $184 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $8 | $8 | $8 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $17 | $25 | $33 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $10 | $44 | $61 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $33 | $43 | $48 |