| Immunization admin injection each additional CPT 90472 • Preventive Care | $1 | $6 | $10 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $67 | $67 | $67 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $230 | $230 | $231 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $52 | $78 | $104 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $20 | $20 | $20 |
| MMR vaccine CPT 90707 • Preventive Care | $52 | $76 | $100 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $6 | $22 | $39 |
| Varicella vaccine CPT 90716 • Preventive Care | $195 | $195 | $196 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $13 | $73 | $133 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $24 | $24 | $24 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $117 | $117 | $118 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $84 | $103 | $122 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $19 | $73 | $127 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $143 | $143 | $144 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $10 | $75 | $139 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $61 | $61 | $61 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $13 | $94 | $174 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $16 | $16 | $16 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $12 | $62 | $112 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $12 | $12 | $12 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $122 | $122 | $122 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $63 | $63 | $63 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $15 | $74 | $133 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $53 | $53 | $53 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $18 | $26 | $35 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $58 | $79 | $100 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $36 | $110 | $185 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $58 | $122 | $185 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $115 | $135 | $154 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $159 | $159 | $160 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $108 | $108 | $109 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $33 | $142 | $252 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $17 | $142 | $267 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $126 | $126 | $126 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $134 | $200 | $267 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $60 | $60 | $60 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $36 | $391 | $747 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $86 | $86 | $86 |
| Spirometry CPT 94010 • Pulmonology | $8 | $23 | $37 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $13 | $37 | $62 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $59 | $59 | $60 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $14 | $27 | $39 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $65 | $115 | $165 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $19 | $19 | $19 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $4 | $4 | $4 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $54 | $54 | $54 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $9 | $26 | $43 |
| Diffusing capacity (DLCO) CPT 94729 • Pulmonology | $9 | $32 | $56 |
| Pulse oximetry single measurement CPT 94760 • Pulmonology | $3 | $3 | $3 |
| Pulse oximetry continuous overnight CPT 94762 • Pulmonology | $26 | $26 | $26 |