| Immunization admin injection each additional CPT 90472 • Preventive Care | $6 | $13 | $21 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $168 | $252 | $336 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $230 | $230 | $231 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $16 | $60 | $104 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $10 | $15 | $20 |
| MMR vaccine CPT 90707 • Preventive Care | $100 | $102 | $103 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $4 | $21 | $39 |
| Varicella vaccine CPT 90716 • Preventive Care | $195 | $195 | $196 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $67 | $100 | $133 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $36 | $128 | $220 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $54 | $118 | $181 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $12 | $101 | $190 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $114 | $156 | $198 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $18 | $59 | $99 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $15 | $115 | $216 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $13 | $13 | $13 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $124 | $198 | $272 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $9 | $52 | $96 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $10 | $56 | $102 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $74 | $83 | $91 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $7 | $59 | $112 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $10 | $62 | $114 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $14 | $111 | $208 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $8 | $53 | $99 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $3 | $33 | $63 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $78 | $78 | $78 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $24 | $42 | $60 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $178 | $178 | $178 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $100 | $186 | $272 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $103 | $133 | $163 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $70 | $99 | $127 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $30 | $174 | $318 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $173 | $259 | $345 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $42 | $184 | $326 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $62 | $238 | $413 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $42 | $118 | $194 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $190 | $568 | $947 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $80 | $80 | $80 |
| Spirometry CPT 94010 • Pulmonology | $25 | $41 | $57 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $11 | $53 | $96 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $25 | $38 | $52 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $22 | $32 | $42 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $42 | $93 | $143 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $8 | $8 | $8 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $16 | $23 | $30 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $10 | $28 | $46 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $19 | $28 | $37 |
| Diffusing capacity (DLCO) CPT 94729 • Pulmonology | $24 | $32 | $40 |
| Pulse oximetry single measurement CPT 94760 • Pulmonology | $3 | $3 | $3 |
| Pulse oximetry continuous overnight CPT 94762 • Pulmonology | $11 | $17 | $22 |