| Immunization admin injection each additional CPT 90472 • Preventive Care | $5 | $8 | $12 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $67 | $198 | $329 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $231 | $244 | $258 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $10 | $56 | $102 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $3 | $13 | $22 |
| MMR vaccine CPT 90707 • Preventive Care | $21 | $59 | $97 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $39 | $45 | $50 |
| Varicella vaccine CPT 90716 • Preventive Care | $192 | $194 | $196 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $117 | $125 | $133 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $216 | $227 | $239 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $40 | $68 | $97 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $57 | $80 | $102 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $43 | $75 | $106 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $72 | $81 | $91 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $14 | $50 | $87 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $16 | $76 | $135 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $12 | $79 | $147 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $62 | $67 | $71 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $54 | $61 | $68 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $27 | $60 | $93 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $41 | $72 | $102 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $6 | $42 | $79 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $14 | $63 | $112 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $10 | $65 | $120 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $3 | $21 | $40 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $17 | $33 | $49 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $84 | $186 | $287 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $84 | $124 | $163 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $110 | $115 | $121 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $148 | $150 | $152 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $101 | $110 | $119 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $36 | $138 | $239 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $13 | $72 | $131 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $26 | $137 | $248 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $51 | $196 | $340 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $34 | $197 | $360 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $213 | $216 | $219 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $90 | $93 | $95 |
| Spirometry CPT 94010 • Pulmonology | $19 | $27 | $35 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $20 | $33 | $46 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $58 | $61 | $63 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $20 | $29 | $38 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $68 | $113 | $158 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $5 | $11 | $18 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $4 | $10 | $17 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $12 | $33 | $53 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $12 | $17 | $22 |
| Diffusing capacity (DLCO) CPT 94729 • Pulmonology | $12 | $29 | $47 |
| Pulse oximetry single measurement CPT 94760 • Pulmonology | $2 | $2 | $3 |
| Pulse oximetry continuous overnight CPT 94762 • Pulmonology | $26 | $26 | $26 |