| Immunization admin injection each additional CPT 90472 • Preventive Care | $4 | $4 | $4 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $168 | $251 | $335 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $230 | $230 | $231 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $10 | $10 | $10 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $2 | $2 | $2 |
| MMR vaccine CPT 90707 • Preventive Care | $21 | $21 | $21 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $39 | $39 | $39 |
| Varicella vaccine CPT 90716 • Preventive Care | $29 | $29 | $29 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $133 | $133 | $133 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $24 | $121 | $219 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $36 | $142 | $248 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $83 | $171 | $259 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $58 | $164 | $269 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $14 | $73 | $132 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $33 | $163 | $294 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $74 | $169 | $263 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $81 | $225 | $368 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $63 | $80 | $97 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $36 | $137 | $238 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $25 | $25 | $25 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $9 | $134 | $260 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $39 | $39 | $39 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $85 | $184 | $282 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $67 | $146 | $226 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $14 | $14 | $14 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $77 | $77 | $77 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $30 | $207 | $384 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $175 | $239 | $304 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $110 | $110 | $110 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $138 | $162 | $186 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $147 | $147 | $148 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $185 | $185 | $185 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $25 | $25 | $25 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $31 | $77 | $123 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $36 | $36 | $36 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $40 | $40 | $40 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $253 | $253 | $253 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $76 | $76 | $76 |
| Spirometry CPT 94010 • Pulmonology | $40 | $40 | $40 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $9 | $9 | $9 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $35 | $35 | $35 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $15 | $29 | $43 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $26 | $26 | $26 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $40 | $40 | $40 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $4 | $4 | $4 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $10 | $10 | $10 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $13 | $24 | $35 |
| Diffusing capacity (DLCO) CPT 94729 • Pulmonology | $44 | $44 | $44 |
| Pulse oximetry single measurement CPT 94760 • Pulmonology | $0 | $0 | $0 |
| Pulse oximetry continuous overnight CPT 94762 • Pulmonology | $14 | $16 | $18 |