| Immunization admin injection each additional CPT 90472 • Preventive Care | $13 | $13 | $14 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $316 | $355 | $395 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $197 | $234 | $272 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $99 | $111 | $123 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $19 | $21 | $24 |
| MMR vaccine CPT 90707 • Preventive Care | $94 | $105 | $117 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $40 | $50 | $59 |
| Varicella vaccine CPT 90716 • Preventive Care | $184 | $207 | $230 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $133 | $137 | $141 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $207 | $244 | $282 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $48 | $75 | $101 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $83 | $95 | $106 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $56 | $75 | $94 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $62 | $88 | $113 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $62 | $97 | $136 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $104 | $136 | $161 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $83 | $83 | $83 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $61 | $72 | $83 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $69 | $75 | $82 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $68 | $74 | $79 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $75 | $83 | $91 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $56 | $83 | $112 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $62 | $96 | $124 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $92 | $100 | $107 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $30 | $31 | $32 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $107 | $107 | $107 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $170 | $170 | $170 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $316 | $316 | $316 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $84 | $84 | $84 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $155 | $155 | $155 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $87 | $100 | $121 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $119 | $119 | $119 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $286 | $286 | $286 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $121 | $121 | $121 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $284 | $284 | $284 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $340 | $340 | $340 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $822 | $822 | $822 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $73 | $73 | $73 |
| Spirometry CPT 94010 • Pulmonology | $7 | $13 | $23 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $32 | $34 | $36 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $49 | $49 | $49 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $19 | $26 | $32 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $58 | $58 | $58 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $5 | $10 | $13 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $12 | $13 | $15 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $50 | $52 | $54 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $37 | $38 | $40 |
| Diffusing capacity (DLCO) CPT 94729 • Pulmonology | $8 | $29 | $50 |
| Pulse oximetry single measurement CPT 94760 • Pulmonology | $2 | $2 | $2 |
| Pulse oximetry continuous overnight CPT 94762 • Pulmonology | $23 | $23 | $23 |