| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $10 | $10 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $34 | $184 | $335 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $230 | $230 | $231 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $104 | $104 | $105 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $2 | $11 | $20 |
| MMR vaccine CPT 90707 • Preventive Care | $100 | $102 | $103 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $6 | $22 | $39 |
| Varicella vaccine CPT 90716 • Preventive Care | $98 | $146 | $195 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $13 | $73 | $133 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $239 | $239 | $239 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $79 | $98 | $117 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $18 | $70 | $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 | $14 | $14 | $14 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $21 | $80 | $139 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $61 | $92 | $122 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $26 | $100 | $174 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $16 | $43 | $71 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $79 | $79 | $79 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $39 | $75 | $111 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $89 | $106 | $122 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $19 | $19 | $19 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $133 | $133 | $133 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $106 | $106 | $106 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $7 | $21 | $35 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $100 | $100 | $100 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $37 | $37 | $37 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $185 | $185 | $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 | $50 | $151 | $252 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $27 | $147 | $267 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $32 | $142 | $253 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $27 | $147 | $267 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $109 | $109 | $109 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $75 | $411 | $747 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $86 | $86 | $86 |
| Spirometry CPT 94010 • Pulmonology | $19 | $28 | $37 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $13 | $37 | $62 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $27 | $43 | $59 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $39 | $39 | $40 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $33 | $99 | $165 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $4 | $4 | $4 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $9 | $21 | $32 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $27 | $41 | $54 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $21 | $32 | $43 |
| Diffusing capacity (DLCO) CPT 94729 • Pulmonology | $11 | $34 | $56 |
| Pulse oximetry single measurement CPT 94760 • Pulmonology | $2 | $2 | $2 |
| Pulse oximetry continuous overnight CPT 94762 • Pulmonology | $26 | $26 | $26 |