| Immunization admin injection single CPT 90471 • Preventive Care | $20 | $20 | $20 |
| Immunization admin injection each additional CPT 90472 • Preventive Care | $2 | $8 | $15 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $168 | $168 | $168 |
| 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 | $4 | $12 | $20 |
| MMR vaccine CPT 90707 • Preventive Care | $137 | $137 | $137 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $6 | $31 | $55 |
| Varicella vaccine CPT 90716 • Preventive Care | $24 | $132 | $240 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $20 | $77 | $133 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $48 | $133 | $219 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $41 | $63 | $84 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $6 | $47 | $88 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $42 | $66 | $91 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $15 | $15 | $15 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $77 | $132 | $187 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $169 | $193 | $217 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $80 | $102 | $125 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $8 | $31 | $55 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $7 | $45 | $83 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $60 | $71 | $82 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $14 | $52 | $91 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $126 | $126 | $126 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $12 | $96 | $180 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $16 | $16 | $16 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $3 | $20 | $37 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $179 | $179 | $179 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $36 | $36 | $36 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $51 | $100 | $149 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $157 | $160 | $162 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $156 | $158 | $161 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $88 | $88 | $88 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $31 | $38 | $45 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $45 | $69 | $93 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $26 | $139 | $252 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $15 | $30 | $45 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $259 | $259 | $259 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $20 | $591 | $1,162 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $88 | $88 | $88 |
| Spirometry CPT 94010 • Pulmonology | $27 | $36 | $45 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $27 | $36 | $45 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $28 | $36 | $45 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $30 | $33 | $36 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $45 | $98 | $150 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $5 | $25 | $44 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $3 | $24 | $45 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $51 | $52 | $52 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $30 | $35 | $40 |
| Diffusing capacity (DLCO) CPT 94729 • Pulmonology | $8 | $31 | $53 |
| Pulse oximetry single measurement CPT 94760 • Pulmonology | $2 | $2 | $2 |