| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $114 | $114 | $114 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $122 | $122 | $122 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $163 | $163 | $163 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $163 | $163 | $163 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $127 | $127 | $127 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $30 | $30 | $30 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $30 | $30 | $30 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $30 | $30 | $30 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $30 | $30 | $30 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $30 | $30 | $30 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $91 | $91 | $91 |
| Spirometry CPT 94010 • Pulmonology | $30 | $30 | $30 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $37 | $37 | $37 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $59 | $59 | $59 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $36 | $36 | $36 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $150 | $150 | $150 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $30 | $30 | $30 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $30 | $30 | $30 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $52 | $52 | $52 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $42 | $42 | $42 |
| Diffusing capacity (DLCO) CPT 94729 • Pulmonology | $55 | $55 | $55 |
| Radiation therapy planning simple CPT 77261 • Radiation Therapy | $69 | $69 | $69 |
| Radiation therapy planning intermediate CPT 77262 • Radiation Therapy | $105 | $105 | $105 |
| Radiation therapy planning complex CPT 77263 • Radiation Therapy | $164 | $164 | $164 |
| Radiation therapy simulation complex CPT 77290 • Radiation Therapy | $439 | $439 | $439 |
| Radiation therapy dose calculation CPT 77300 • Radiation Therapy | $62 | $62 | $62 |
| Radiation treatment device design complex CPT 77334 • Radiation Therapy | $119 | $119 | $119 |
| Stereotactic radiosurgery (SRS) cranial CPT 77371 • Radiation Therapy | $1,058 | $1,544 | $2,030 |
| Stereotactic body radiation therapy (SBRT) CPT 77373 • Radiation Therapy | $964 | $964 | $964 |
| Radiation treatment delivery 3 or more MeV CPT 77412 • Radiation Therapy | $30 | $30 | $30 |
| Radiation treatment management 5 treatments CPT 77427 • Radiation Therapy | $186 | $186 | $186 |
| Sleep study unattended CPT 95800 • Sleep Medicine | $131 | $131 | $131 |
| Sleep study unattended minimum 3 channels CPT 95801 • Sleep Medicine | $74 | $74 | $74 |
| Polysomnography with CPAP titration CPT 95811 • Sleep Medicine | $516 | $516 | $516 |
| CPAP combination oral/nasal mask HCPCS A7027 • Sleep Medicine | $153 | $153 | $153 |
| Respiratory assist device BiPAP without backup HCPCS E0470 • Sleep Medicine | $1,219 | $1,219 | $1,219 |
| CPAP device continuous positive airway pressure HCPCS E0601 • Sleep Medicine | $498 | $498 | $498 |
| Laparoscopic partial nephrectomy CPT 50543 • Urology | $30 | $30 | $30 |
| Laparoscopic radical nephrectomy CPT 50545 • Urology | $30 | $30 | $30 |
| Lithotripsy extracorporeal shock wave (ESWL) CPT 50590 • Urology | $30 | $30 | $30 |
| Complex uroflowmetry CPT 51741 • Urology | $30 | $30 | $30 |
| Cystourethroscopy diagnostic CPT 52000 • Urology | $30 | $30 | $30 |
| Cystourethroscopy with tumor fulguration small CPT 52234 • Urology | $238 | $238 | $238 |
| Cystourethroscopy with tumor fulguration medium CPT 52235 • Urology | $30 | $30 | $30 |
| Cystourethroscopy with dilation of ureteral stricture CPT 52260 • Urology | $204 | $204 | $204 |
| Cystourethroscopy with ureteral stent insertion CPT 52332 • Urology | $30 | $30 | $30 |
| Cystourethroscopy with lithotripsy CPT 52353 • Urology | $30 | $30 | $30 |
| TURP transurethral resection of prostate CPT 52601 • Urology | $30 | $30 | $30 |
| Laser vaporization of prostate CPT 52648 • Urology | $30 | $30 | $30 |
| Circumcision CPT 54150 • Urology | $30 | $30 | $30 |