| Immunization admin injection each additional CPT 90472 • Preventive Care | $2 | $10 | $20 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $27 | $205 | $378 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $113 | $205 | $297 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $88 | $100 | $120 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $2 | $14 | $26 |
| MMR vaccine CPT 90707 • Preventive Care | $72 | $96 | $114 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $4 | $40 | $59 |
| Varicella vaccine CPT 90716 • Preventive Care | $124 | $255 | $419 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $27 | $82 | $138 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $120 | $175 | $254 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $59 | $84 | $109 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $108 | $110 | $111 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $8 | $85 | $154 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $9 | $91 | $186 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $14 | $99 | $180 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $15 | $105 | $209 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $115 | $137 | $160 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $63 | $91 | $127 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $82 | $107 | $146 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $10 | $74 | $145 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $102 | $114 | $126 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $57 | $108 | $152 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $87 | $127 | $173 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $66 | $119 | $186 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $4 | $21 | $37 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $128 | $146 | $165 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $90 | $206 | $322 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $77 | $199 | $322 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $78 | $88 | $99 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $158 | $173 | $187 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $89 | $106 | $123 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $24 | $77 | $130 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $265 | $286 | $306 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $85 | $139 | $199 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $154 | $164 | $174 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $35 | $174 | $314 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $337 | $488 | $639 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $73 | $78 | $83 |
| Spirometry CPT 94010 • Pulmonology | $7 | $8 | $11 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $14 | $31 | $49 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $30 | $55 | $79 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $37 | $44 | $50 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $32 | $65 | $98 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $2 | $10 | $19 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $16 | $18 | $19 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $17 | $36 | $48 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $10 | $20 | $30 |
| Diffusing capacity (DLCO) CPT 94729 • Pulmonology | $9 | $11 | $12 |
| Pulse oximetry single measurement CPT 94760 • Pulmonology | $1 | $2 | $3 |
| Pulse oximetry continuous overnight CPT 94762 • Pulmonology | $5 | $9 | $12 |