| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $5 | $86 | $127 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $5 | $76 | $147 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $159 | $159 | $160 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $5 | $51 | $96 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $51 | $82 | $102 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $68 | $85 | $101 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $102 | $108 | $111 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $103 | $108 | $114 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $5 | $83 | $122 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $5 | $61 | $131 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $38 | $38 | $38 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $183 | $183 | $183 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $90 | $214 | $338 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $338 | $338 | $338 |
| 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 | $177 | $227 | $243 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $273 | $317 | $406 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $131 | $188 | $252 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $210 | $302 | $348 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $371 | $405 | $474 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $294 | $950 | $1,278 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $90 | $91 | $91 |
| Spirometry CPT 94010 • Pulmonology | $25 | $27 | $34 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $37 | $38 | $39 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $27 | $48 | $59 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $36 | $36 | $37 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $78 | $126 | $150 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $10 | $11 | $12 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $13 | $15 | $16 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $15 | $43 | $52 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $8 | $35 | $48 |
| Diffusing capacity (DLCO) CPT 94729 • Pulmonology | $10 | $37 | $55 |
| Pulse oximetry single measurement CPT 94760 • Pulmonology | $2 | $3 | $5 |
| Pulse oximetry continuous overnight CPT 94762 • Pulmonology | $5 | $20 | $25 |
| Radiation therapy planning simple CPT 77261 • Radiation Therapy | $69 | $72 | $79 |
| Radiation therapy planning intermediate CPT 77262 • Radiation Therapy | $105 | $110 | $120 |
| Radiation therapy planning complex CPT 77263 • Radiation Therapy | $164 | $169 | $178 |
| Radiation therapy simulation simple CPT 77280 • Radiation Therapy | $129 | $195 | $257 |
| Radiation therapy simulation complex CPT 77290 • Radiation Therapy | $260 | $352 | $439 |
| 3-dimensional radiation therapy plan CPT 77295 • Radiation Therapy | $457 | $761 | $1,369 |
| Radiation therapy dose calculation CPT 77300 • Radiation Therapy | $31 | $60 | $88 |
| IMRT radiation therapy plan CPT 77301 • Radiation Therapy | $411 | $1,255 | $1,747 |
| Radiation treatment device design complex CPT 77334 • Radiation Therapy | $60 | $83 | $119 |
| Radiation physics consultation CPT 77336 • Radiation Therapy | $77 | $88 | $119 |
| Stereotactic radiosurgery (SRS) cranial CPT 77371 • Radiation Therapy | $1,058 | $1,086 | $1,170 |
| Stereotactic body radiation therapy (SBRT) CPT 77373 • Radiation Therapy | $5 | $644 | $964 |
| Radiation treatment delivery superficial CPT 77407 • Radiation Therapy | $5 | $116 | $172 |
| Radiation treatment delivery 3 or more MeV CPT 77412 • Radiation Therapy | $93 | $183 | $228 |