| Immunization admin injection each additional CPT 90472 • Preventive Care | $10 | $11 | $13 |
| HPV vaccine 9-valent CPT 90651 • Preventive Care | $316 | $326 | $336 |
| Pneumococcal conjugate vaccine 13-valent CPT 90670 • Preventive Care | $258 | $258 | $258 |
| Rotavirus vaccine pentavalent CPT 90680 • Preventive Care | $14 | $56 | $99 |
| Influenza vaccine quadrivalent preservative free CPT 90686 • Preventive Care | $2 | $10 | $19 |
| MMR vaccine CPT 90707 • Preventive Care | $19 | $55 | $91 |
| Tdap vaccine age 7 years or older CPT 90715 • Preventive Care | $4 | $22 | $40 |
| Varicella vaccine CPT 90716 • Preventive Care | $46 | $115 | $184 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $20 | $20 | $20 |
| Zoster vaccine recombinant adjuvanted CPT 90750 • Preventive Care | $37 | $107 | $176 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $16 | $59 | $101 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $37 | $67 | $96 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $83 | $89 | $94 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $66 | $89 | $113 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $13 | $71 | $129 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $12 | $79 | $147 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $124 | $124 | $124 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $16 | $57 | $98 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $10 | $46 | $82 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $96 | $100 | $104 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $17 | $60 | $104 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $11 | $63 | $115 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $105 | $114 | $123 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $66 | $99 | $133 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $39 | $39 | $39 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $7 | $7 | $7 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $180 | $208 | $235 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $74 | $135 | $195 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $142 | $142 | $142 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $130 | $134 | $137 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $103 | $117 | $131 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $295 | $295 | $295 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $29 | $29 | $29 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $120 | $120 | $120 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $83 | $83 | $83 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $139 | $251 | $364 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $639 | $639 | $639 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $91 | $91 | $91 |
| Spirometry CPT 94010 • Pulmonology | $8 | $14 | $19 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $32 | $32 | $33 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $30 | $30 | $30 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $14 | $14 | $14 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $150 | $150 | $150 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $4 | $6 | $7 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $8 | $12 | $17 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $11 | $11 | $12 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $44 | $44 | $44 |
| Diffusing capacity (DLCO) CPT 94729 • Pulmonology | $46 | $47 | $47 |
| Pulse oximetry single measurement CPT 94760 • Pulmonology | $1 | $1 | $1 |
| Pulse oximetry continuous overnight CPT 94762 • Pulmonology | $13 | $16 | $20 |