| MMR vaccine CPT 90707 • Preventive Care | $45 | $45 | $45 |
| Pneumococcal vaccine adult CPT 90732 • Preventive Care | $20 | $20 | $20 |
| Preventive visit new patient infant CPT 99381 • Preventive Care | $63 | $63 | $63 |
| Preventive visit new patient age 1-4 CPT 99382 • Preventive Care | $64 | $64 | $64 |
| Preventive visit new patient age 5-11 CPT 99383 • Preventive Care | $68 | $68 | $68 |
| Preventive visit new patient age 12-17 CPT 99384 • Preventive Care | $79 | $79 | $79 |
| Preventive visit new patient age 18-39 CPT 99385 • Preventive Care | $91 | $91 | $91 |
| Preventive visit new patient age 40-64 CPT 99386 • Preventive Care | $98 | $98 | $98 |
| Preventive visit new patient age 65+ CPT 99387 • Preventive Care | $108 | $108 | $108 |
| Preventive visit established patient infant CPT 99391 • Preventive Care | $40 | $40 | $40 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $43 | $43 | $43 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $46 | $46 | $46 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $55 | $55 | $55 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $60 | $60 | $60 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $66 | $66 | $66 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $81 | $81 | $81 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $282 | $282 | $282 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $319 | $319 | $319 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $383 | $383 | $383 |
| Spirometry CPT 94010 • Pulmonology | $31 | $31 | $31 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $59 | $59 | $59 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $89 | $89 | $89 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $37 | $37 | $37 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $14 | $14 | $14 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $19 | $19 | $19 |
| Pulse oximetry single measurement CPT 94760 • Pulmonology | $9 | $9 | $9 |
| Pulse oximetry continuous overnight CPT 94762 • Pulmonology | $40 | $40 | $40 |
| Radiation therapy planning simple CPT 77261 • Radiation Therapy | $74 | $74 | $74 |
| Radiation therapy planning intermediate CPT 77262 • Radiation Therapy | $112 | $112 | $112 |
| Radiation therapy planning complex CPT 77263 • Radiation Therapy | $167 | $167 | $167 |
| Radiation therapy simulation simple CPT 77280 • Radiation Therapy | $155 | $155 | $155 |
| Radiation therapy simulation complex CPT 77290 • Radiation Therapy | $303 | $303 | $303 |
| 3-dimensional radiation therapy plan CPT 77295 • Radiation Therapy | $1,187 | $1,187 | $1,187 |
| Radiation therapy dose calculation CPT 77300 • Radiation Therapy | $78 | $78 | $78 |
| Radiation treatment device design complex CPT 77334 • Radiation Therapy | $175 | $175 | $175 |
| Radiation physics consultation CPT 77336 • Radiation Therapy | $101 | $101 | $101 |
| Radiation treatment delivery superficial CPT 77407 • Radiation Therapy | $70 | $70 | $70 |
| Radiation treatment delivery 3 or more MeV CPT 77412 • Radiation Therapy | $79 | $79 | $79 |
| Radiation therapy management complete course CPT 77431 • Radiation Therapy | $97 | $97 | $97 |
| Multiple sleep latency test (MSLT) CPT 95805 • Sleep Medicine | $231 | $231 | $231 |
| Polysomnography age 6 or older CPT 95810 • Sleep Medicine | $297 | $297 | $297 |
| Lithotripsy extracorporeal shock wave (ESWL) CPT 50590 • Urology | $869 | $869 | $869 |
| Complex uroflowmetry CPT 51741 • Urology | $94 | $94 | $94 |
| Cystourethroscopy diagnostic CPT 52000 • Urology | $147 | $147 | $147 |
| Cystourethroscopy with tumor fulguration small CPT 52234 • Urology | $540 | $540 | $540 |
| Cystourethroscopy with tumor fulguration medium CPT 52235 • Urology | $574 | $574 | $574 |
| Cystourethroscopy with dilation of ureteral stricture CPT 52260 • Urology | $267 | $267 | $267 |
| Cystourethroscopy with ureteral stent insertion CPT 52332 • Urology | $266 | $266 | $266 |
| TURP transurethral resection of prostate CPT 52601 • Urology | $1,030 | $1,030 | $1,030 |
| Laser vaporization of prostate CPT 52648 • Urology | $892 | $892 | $892 |