| Polysomnography under age 6 CPT 95782 • Sleep Medicine | $662 | $715 | $768 |
| Polysomnography under age 6 with CPAP CPT 95783 • Sleep Medicine | $699 | $756 | $813 |
| Sleep study unattended CPT 95800 • Sleep Medicine | $96 | $96 | $96 |
| Sleep study unattended minimum 3 channels CPT 95801 • Sleep Medicine | $40 | $57 | $75 |
| Multiple sleep latency test (MSLT) CPT 95805 • Sleep Medicine | $291 | $357 | $424 |
| Polysomnography age 6 or older CPT 95810 • Sleep Medicine | $395 | $501 | $606 |
| Polysomnography with CPAP titration CPT 95811 • Sleep Medicine | $103 | $103 | $103 |
| CPAP combination oral/nasal mask HCPCS A7027 • Sleep Medicine | $153 | $153 | $154 |
| Respiratory assist device BiPAP without backup HCPCS E0470 • Sleep Medicine | $987 | $987 | $987 |
| CPAP device continuous positive airway pressure HCPCS E0601 • Sleep Medicine | $498 | $498 | $499 |
| Laparoscopic partial nephrectomy CPT 50543 • Urology | $1,399 | $1,399 | $1,399 |
| 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 | $3 | $5 | $8 |
| Post-void residual urine measurement CPT 51798 • Urology | $9 | $9 | $9 |
| Cystourethroscopy diagnostic CPT 52000 • Urology | $75 | $75 | $75 |
| Cystourethroscopy with tumor fulguration small CPT 52234 • Urology | $238 | $238 | $238 |
| Cystourethroscopy with tumor fulguration medium CPT 52235 • Urology | $30 | $30 | $30 |
| Cystourethroscopy with ureteral stent insertion CPT 52332 • Urology | $399 | $399 | $399 |
| 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 | $506 | $506 | $506 |
| Circumcision CPT 54150 • Urology | $30 | $30 | $30 |
| Orchiectomy simple CPT 54520 • Urology | $337 | $337 | $337 |
| Orchiectomy radical inguinal CPT 54530 • Urology | $30 | $30 | $30 |
| Vasectomy CPT 55250 • Urology | $49 | $49 | $49 |
| Radical prostatectomy retropubic CPT 55840 • Urology | $30 | $30 | $30 |
| Laparoscopic radical prostatectomy CPT 55866 • Urology | $30 | $30 | $30 |