| Preventive visit established patient infant CPT 99391 • Preventive Care | $5 | $51 | $96 |
| Preventive visit established patient age 1-4 CPT 99392 • Preventive Care | $5 | $54 | $102 |
| Preventive visit established patient age 5-11 CPT 99393 • Preventive Care | $71 | $86 | $101 |
| Preventive visit established patient age 12-17 CPT 99394 • Preventive Care | $5 | $58 | $111 |
| Preventive visit established patient age 18-39 CPT 99395 • Preventive Care | $5 | $60 | $114 |
| Preventive visit established patient age 40-64 CPT 99396 • Preventive Care | $5 | $64 | $122 |
| Preventive visit established patient age 65+ CPT 99397 • Preventive Care | $5 | $68 | $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 | $338 | $338 | $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 | $243 | $314 | $385 |
| Bronchoscopy with brushing CPT 31623 • Pulmonology | $187 | $230 | $273 |
| Bronchoscopy with bronchial alveolar lavage CPT 31624 • Pulmonology | $187 | $220 | $252 |
| Bronchoscopy with biopsy CPT 31625 • Pulmonology | $348 | $384 | $420 |
| Bronchoscopy with transbronchial lung biopsy CPT 31628 • Pulmonology | $243 | $307 | $371 |
| Bronchoscopy with endobronchial ultrasound biopsy CPT 31652 • Pulmonology | $307 | $792 | $1,278 |
| Ventilation assist and management initiation CPT 94002 • Pulmonology | $91 | $93 | $94 |
| Spirometry CPT 94010 • Pulmonology | $25 | $25 | $26 |
| Spirometry before and after bronchodilator CPT 94060 • Pulmonology | $37 | $39 | $41 |
| Bronchospasm provocation evaluation CPT 94070 • Pulmonology | $34 | $47 | $59 |
| Respiratory flow volume loop CPT 94375 • Pulmonology | $21 | $29 | $36 |
| Cardiopulmonary exercise test CPT 94621 • Pulmonology | $81 | $116 | $150 |
| Nebulizer inhalation treatment CPT 94640 • Pulmonology | $10 | $11 | $13 |
| Aerosol or vapor inhalation initial demonstration CPT 94664 • Pulmonology | $14 | $15 | $16 |
| Plethysmography lung volumes CPT 94726 • Pulmonology | $49 | $50 | $52 |
| Gas dilution lung volumes CPT 94727 • Pulmonology | $42 | $46 | $51 |
| Diffusing capacity (DLCO) CPT 94729 • Pulmonology | $10 | $33 | $55 |
| Pulse oximetry single measurement CPT 94760 • Pulmonology | $2 | $2 | $2 |
| Pulse oximetry continuous overnight CPT 94762 • Pulmonology | $22 | $23 | $25 |
| Radiation therapy planning simple CPT 77261 • Radiation Therapy | $69 | $76 | $83 |
| Radiation therapy planning intermediate CPT 77262 • Radiation Therapy | $105 | $115 | $125 |
| Radiation therapy planning complex CPT 77263 • Radiation Therapy | $164 | $175 | $186 |
| Radiation therapy simulation simple CPT 77280 • Radiation Therapy | $40 | $149 | $257 |
| Radiation therapy simulation complex CPT 77290 • Radiation Therapy | $272 | $356 | $439 |
| 3-dimensional radiation therapy plan CPT 77295 • Radiation Therapy | $457 | $812 | $1,167 |
| Radiation therapy dose calculation CPT 77300 • Radiation Therapy | $36 | $49 | $62 |
| IMRT radiation therapy plan CPT 77301 • Radiation Therapy | $1,167 | $1,457 | $1,747 |
| Radiation treatment device design complex CPT 77334 • Radiation Therapy | $72 | $95 | $119 |
| Radiation physics consultation CPT 77336 • Radiation Therapy | $77 | $101 | $125 |
| Stereotactic radiosurgery (SRS) cranial CPT 77371 • Radiation Therapy | $5 | $532 | $1,058 |
| Stereotactic body radiation therapy (SBRT) CPT 77373 • Radiation Therapy | $5 | $485 | $964 |
| Radiation treatment delivery superficial CPT 77407 • Radiation Therapy | $5 | $89 | $172 |
| Radiation treatment delivery 3 or more MeV CPT 77412 • Radiation Therapy | $98 | $163 | $228 |
| Radiation treatment management 5 treatments CPT 77427 • Radiation Therapy | $186 | $189 | $192 |
| Radiation therapy management complete course CPT 77431 • Radiation Therapy | $104 | $106 | $109 |
| Proton beam treatment simple CPT 77520 • Radiation Therapy | $831 | $922 | $1,012 |