| Immunization admin injection each additional CPT 90472 • Preventive Care | $5 | $8 | $11 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $312 | $324 | $336 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $258 | $275 | $292 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $14 | $55 | $97 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $3 | $12 | $21 |
| MMR vaccine CPT 90707 • Preventive Care | $93 | $101 | $109 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $38 | $47 | $56 |
| Varicella vaccine CPT 90716 • Preventive Care | $33 | $125 | $217 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $13 | $62 | $111 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $42 | $143 | $244 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $37 | $48 | $59 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $65 | $126 | $187 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $12 | $52 | $93 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $10 | $115 | $221 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $127 | $144 | $160 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $22 | $70 | $117 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $102 | $156 | $209 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $82 | $98 | $115 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $51 | $55 | $59 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $7 | $89 | $171 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $8 | $38 | $67 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $9 | $101 | $193 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $94 | $150 | $205 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $99 | $160 | $221 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $4 | $17 | $31 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $18 | $31 | $44 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $38 | $91 | $145 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $18 | $137 | $255 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $110 | $188 | $266 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $163 | $218 | $273 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $127 | $156 | $185 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $97 | $245 | $393 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $48 | $128 | $207 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $131 | $270 | $408 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $25 | $292 | $559 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $86 | $112 | $137 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $38 | $910 | $1,782 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $83 | $117 | $150 |
| Spirometry CPT 94010 • Pulmonology | $14 | $16 | $18 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $10 | $19 | $27 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $23 | $26 | $28 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $30 | $33 | $37 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $54 | $68 | $82 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $5 | $9 | $14 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $8 | $18 | $27 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $12 | $39 | $66 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $20 | $27 | $33 |
| Diffusing capacity (DLCO) CPT 94729 • Pulmonology | $32 | $61 | $91 |
| Pulse oximetry single measurement CPT 94760 • Pulmonology | $4 | $4 | $4 |
| Pulse oximetry continuous overnight CPT 94762 • Pulmonology | $5 | $13 | $20 |