| Immunization admin injection each additional CPT 90472 • Preventive Care | $11 | $12 | $13 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $168 | $270 | $371 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $231 | $261 | $292 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $105 | $110 | $115 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $20 | $23 | $25 |
| MMR vaccine CPT 90707 • Preventive Care | $15 | $62 | $109 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $6 | $31 | $56 |
| Varicella vaccine CPT 90716 • Preventive Care | $98 | $157 | $217 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $132 | $133 | $133 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $239 | $241 | $244 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $8 | $37 | $67 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $12 | $42 | $72 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $58 | $82 | $105 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $45 | $71 | $97 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $33 | $74 | $115 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $104 | $124 | $143 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $115 | $130 | $145 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $32 | $59 | $87 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $7 | $50 | $92 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $7 | $50 | $92 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $9 | $55 | $101 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $39 | $71 | $104 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $66 | $88 | $110 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $7 | $68 | $128 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $4 | $15 | $25 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $5 | $79 | $153 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $152 | $158 | $164 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $104 | $134 | $164 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $110 | $132 | $154 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $138 | $148 | $158 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $91 | $99 | $107 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $62 | $137 | $211 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $199 | $226 | $253 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $128 | $157 | $186 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $145 | $147 | $149 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $63 | $115 | $167 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $31 | $531 | $1,032 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $76 | $81 | $87 |
| Spirometry CPT 94010 • Pulmonology | $20 | $22 | $25 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $34 | $37 | $40 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $23 | $25 | $26 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $13 | $14 | $15 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $77 | $102 | $128 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $6 | $10 | $15 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $2 | $8 | $14 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $38 | $42 | $45 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $7 | $24 | $41 |
| Diffusing capacity (DLCO) CPT 94729 • Pulmonology | $9 | $23 | $37 |
| Pulse oximetry single measurement CPT 94760 • Pulmonology | $1 | $2 | $2 |
| Pulse oximetry continuous overnight CPT 94762 • Pulmonology | $9 | $16 | $23 |