| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $59 | $59 | $59 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $63 | $73 | $84 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $89 | $89 | $89 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $70 | $73 | $77 |
| Cervical or vaginal cancer screening pelvic exam HCPCS G0101 • Preventive Care | $20 | $20 | $20 |
| Colorectal cancer screening flexible sigmoidoscopy HCPCS G0104 • Preventive Care | $41 | $41 | $41 |
| Colorectal cancer screening colonoscopy high risk HCPCS G0105 • Preventive Care | $66 | $66 | $66 |
| Colorectal cancer screening colonoscopy not high risk HCPCS G0121 • Preventive Care | $123 | $123 | $123 |
| Initial preventive physical exam (Welcome to Medicare) HCPCS G0402 • Preventive Care | $180 | $180 | $180 |
| Annual wellness visit initial HCPCS G0438 • Preventive Care | $119 | $119 | $119 |
| Annual wellness visit subsequent HCPCS G0439 • Preventive Care | $94 | $94 | $94 |
| Bronchoscopy diagnostic CPT 31622 • Pulmonology | $113 | $113 | $113 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $124 | $124 | $124 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $141 | $141 | $141 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $251 | $251 | $251 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $267 | $267 | $267 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $155 | $155 | $155 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $65 | $65 | $65 |
| Spirometry CPT 94010 • Pulmonology | $6 | $6 | $6 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $21 | $21 | $21 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $26 | $26 | $26 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $18 | $18 | $18 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $64 | $64 | $64 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $6 | $6 | $6 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $13 | $13 | $13 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $8 | $8 | $8 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $32 | $32 | $32 |
| Diffusing capacity (DLCO) CPT 94729 • Pulmonology | $41 | $41 | $41 |
| Pulse oximetry single measurement CPT 94760 • Pulmonology | $2 | $2 | $2 |
| Pulse oximetry continuous overnight CPT 94762 • Pulmonology | $18 | $18 | $18 |
| Radiation therapy planning simple CPT 77261 • Radiation Therapy | $76 | $76 | $76 |
| Radiation therapy planning intermediate CPT 77262 • Radiation Therapy | $78 | $78 | $78 |
| Radiation therapy planning complex CPT 77263 • Radiation Therapy | $120 | $120 | $120 |
| Radiation therapy simulation simple CPT 77280 • Radiation Therapy | $291 | $291 | $291 |
| Radiation therapy simulation complex CPT 77290 • Radiation Therapy | $264 | $264 | $264 |
| 3-dimensional radiation therapy plan CPT 77295 • Radiation Therapy | $186 | $186 | $186 |
| Radiation therapy dose calculation CPT 77300 • Radiation Therapy | $24 | $24 | $24 |
| IMRT radiation therapy plan CPT 77301 • Radiation Therapy | $1,030 | $1,030 | $1,030 |
| Radiation treatment device design complex CPT 77334 • Radiation Therapy | $47 | $47 | $47 |
| Radiation physics consultation CPT 77336 • Radiation Therapy | $64 | $64 | $64 |
| Stereotactic body radiation therapy (SBRT) CPT 77373 • Radiation Therapy | $717 | $717 | $717 |
| Radiation treatment delivery superficial CPT 77407 • Radiation Therapy | $228 | $228 | $228 |
| Radiation treatment delivery 3 or more MeV CPT 77412 • Radiation Therapy | $488 | $488 | $488 |
| Radiation treatment management 5 treatments CPT 77427 • Radiation Therapy | $205 | $205 | $205 |
| Radiation therapy management complete course CPT 77431 • Radiation Therapy | $77 | $77 | $77 |
| Polysomnography under age 6 CPT 95782 • Sleep Medicine | $87 | $87 | $87 |
| Polysomnography under age 6 with CPAP CPT 95783 • Sleep Medicine | $95 | $95 | $95 |
| Sleep study unattended CPT 95800 • Sleep Medicine | $98 | $98 | $98 |
| Sleep study unattended minimum 3 channels CPT 95801 • Sleep Medicine | $70 | $70 | $70 |
| Multiple sleep latency test (MSLT) CPT 95805 • Sleep Medicine | $40 | $40 | $40 |