| Respiratory assist device BiPAP without backup HCPCS E0470 • Sleep Medicine | $914 | $914 | $914 |
| CPAP device continuous positive airway pressure HCPCS E0601 • Sleep Medicine | $50 | $274 | $498 |
| Laparoscopic partial nephrectomy CPT 50543 • Urology | $30 | $30 | $30 |
| 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 | $30 | $30 | $30 |
| Post-void residual urine measurement CPT 51798 • Urology | $9 | $9 | $9 |
| Cystourethroscopy diagnostic CPT 52000 • Urology | $78 | $78 | $78 |
| 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 | $199 | $199 | $199 |
| 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 | $30 | $30 | $30 |
| Circumcision CPT 54150 • Urology | $30 | $30 | $30 |
| Orchiectomy simple CPT 54520 • Urology | $30 | $30 | $30 |
| Orchiectomy radical inguinal CPT 54530 • Urology | $30 | $30 | $30 |
| Vasectomy CPT 55250 • Urology | $155 | $155 | $155 |
| Radical prostatectomy retropubic CPT 55840 • Urology | $30 | $30 | $30 |
| Laparoscopic radical prostatectomy CPT 55866 • Urology | $30 | $30 | $30 |