| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $13 | $18 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $268 | $299 | $329 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $230 | $249 | $258 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $92 | $99 | $104 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $19 | $20 | $22 |
| MMR vaccine CPT 90707 • Preventive Care | $14 | $75 | $100 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $34 | $41 | $50 |
| Varicella vaccine CPT 90716 • Preventive Care | $33 | $151 | $195 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $13 | $65 | $117 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $37 | $162 | $219 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $51 | $83 | $109 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $79 | $97 | $111 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $57 | $96 | $118 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $92 | $110 | $133 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $90 | $107 | $129 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $103 | $134 | $152 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $85 | $107 | $129 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $68 | $82 | $100 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $61 | $72 | $82 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $72 | $87 | $102 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $57 | $82 | $112 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $59 | $88 | $116 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $86 | $105 | $123 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $11 | $70 | $133 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $4 | $23 | $38 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $128 | $156 | $184 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $18 | $164 | $238 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $235 | $237 | $238 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $116 | $147 | $164 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $115 | $144 | $168 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $91 | $109 | $127 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $94 | $170 | $208 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $92 | $161 | $231 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $45 | $137 | $189 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $30 | $185 | $283 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $139 | $255 | $371 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $702 | $942 | $1,278 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $64 | $69 | $75 |
| Spirometry CPT 94010 • Pulmonology | $19 | $24 | $30 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $7 | $29 | $48 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $25 | $36 | $47 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $10 | $20 | $30 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $30 | $88 | $128 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $6 | $9 | $14 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $13 | $26 | $45 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $30 | $40 | $47 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $7 | $16 | $33 |
| Diffusing capacity (DLCO) CPT 94729 • Pulmonology | $33 | $41 | $46 |
| Pulse oximetry single measurement CPT 94760 • Pulmonology | $2 | $2 | $2 |
| Pulse oximetry continuous overnight CPT 94762 • Pulmonology | $17 | $19 | $20 |