| Immunization admin each additional component CPT 90461 • Preventive Care | $8 | $10 | $12 |
| Immunization admin injection single CPT 90471 • Preventive Care | $10 | $15 | $24 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $9 | $11 | $12 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $269 | $305 | $369 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $254 | $256 | $258 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $84 | $100 | $115 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $5 | $16 | $22 |
| MMR vaccine CPT 90707 • Preventive Care | $91 | $95 | $107 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $34 | $42 | $55 |
| Varicella vaccine CPT 90716 • Preventive Care | $163 | $181 | $215 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $117 | $124 | $131 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $176 | $202 | $241 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $5 | $78 | $106 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $80 | $99 | $113 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $94 | $106 | $118 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $72 | $117 | $133 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $103 | $120 | $129 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $117 | $140 | $149 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $5 | $83 | $160 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $70 | $87 | $98 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $5 | $66 | $97 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $56 | $81 | $104 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $64 | $94 | $114 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $5 | $94 | $116 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $5 | $98 | $123 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $5 | $93 | $133 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $37 | $37 | $37 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $56 | $56 | $56 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $235 | $278 | $364 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $191 | $194 | $195 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $124 | $124 | $124 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $130 | $142 | $166 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $103 | $106 | $112 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $144 | $156 | $168 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $320 | $361 | $403 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $171 | $237 | $303 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $382 | $390 | $399 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $139 | $226 | $403 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $306 | $586 | $865 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $86 | $89 | $92 |
| Spirometry CPT 94010 • Pulmonology | $7 | $11 | $19 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $13 | $33 | $54 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $56 | $57 | $58 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $15 | $18 | $20 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $68 | $107 | $145 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $7 | $12 | $17 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $13 | $15 | $17 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $11 | $18 | $38 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $40 | $43 | $46 |
| Diffusing capacity (DLCO) CPT 94729 • Pulmonology | $9 | $40 | $58 |