| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $10 | $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 | $52 | $78 | $104 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $2 | $11 | $20 |
| MMR vaccine CPT 90707 • Preventive Care | $15 | $58 | $100 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $39 | $39 | $39 |
| Varicella vaccine CPT 90716 • Preventive Care | $98 | $146 | $195 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $67 | $67 | $67 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $120 | $120 | $120 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $8 | $41 | $75 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $8 | $45 | $82 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $29 | $56 | $82 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $20 | $20 | $20 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $88 | $88 | $89 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $10 | $57 | $104 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $9 | $61 | $114 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $4 | $4 | $4 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $8 | $8 | $8 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $7 | $7 | $7 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $83 | $83 | $83 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $77 | $77 | $78 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $43 | $64 | $85 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $37 | $37 | $37 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $6 | $17 | $28 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $18 | $18 | $18 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $175 | $175 | $175 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $61 | $82 | $104 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $110 | $110 | $110 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $137 | $137 | $138 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $90 | $90 | $91 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $59 | $152 | $246 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $40 | $152 | $264 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $50 | $86 | $123 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $145 | $206 | $268 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $32 | $32 | $32 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $31 | $396 | $761 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $76 | $76 | $76 |
| Spirometry CPT 94010 • Pulmonology | $20 | $30 | $40 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $46 | $46 | $46 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $24 | $35 | $46 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $18 | $18 | $18 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $26 | $76 | $127 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $9 | $10 | $11 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $2 | $21 | $40 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $27 | $36 | $45 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $25 | $34 | $44 |
| Diffusing capacity (DLCO) CPT 94729 • Pulmonology | $7 | $26 | $44 |
| Pulse oximetry single measurement CPT 94760 • Pulmonology | $1 | $1 | $1 |
| Pulse oximetry continuous overnight CPT 94762 • Pulmonology | $25 | $25 | $25 |