| Radiation therapy planning complex CPT 77263 • Radiation Therapy | $134 | $134 | $134 |
| Radiation therapy simulation simple CPT 77280 • Radiation Therapy | $30 | $30 | $30 |
| Radiation therapy simulation complex CPT 77290 • Radiation Therapy | $66 | $66 | $66 |
| 3-dimensional radiation therapy plan CPT 77295 • Radiation Therapy | $180 | $180 | $180 |
| Radiation therapy dose calculation CPT 77300 • Radiation Therapy | $26 | $26 | $26 |
| IMRT radiation therapy plan CPT 77301 • Radiation Therapy | $336 | $336 | $336 |
| Radiation treatment device design complex CPT 77334 • Radiation Therapy | $48 | $48 | $48 |
| Radiation treatment management 5 treatments CPT 77427 • Radiation Therapy | $155 | $155 | $155 |
| Radiation therapy management complete course CPT 77431 • Radiation Therapy | $84 | $84 | $84 |
| Polysomnography age 6 or older CPT 95810 • Sleep Medicine | $588 | $588 | $588 |
| Polysomnography with CPAP titration CPT 95811 • Sleep Medicine | $620 | $620 | $620 |
| Respiratory assist device BiPAP without backup HCPCS E0470 • Sleep Medicine | $467 | $467 | $467 |
| CPAP device continuous positive airway pressure HCPCS E0601 • Sleep Medicine | $85 | $144 | $203 |
| Laparoscopic partial nephrectomy CPT 50543 • Urology | $1,754 | $1,754 | $1,754 |
| Laparoscopic radical nephrectomy CPT 50545 • Urology | $1,459 | $1,459 | $1,459 |
| Lithotripsy extracorporeal shock wave (ESWL) CPT 50590 • Urology | $675 | $675 | $675 |
| Complex uroflowmetry CPT 51741 • Urology | $14 | $14 | $14 |
| Post-void residual urine measurement CPT 51798 • Urology | $12 | $12 | $12 |
| Cystourethroscopy diagnostic CPT 52000 • Urology | $245 | $245 | $245 |
| Cystourethroscopy with tumor fulguration small CPT 52234 • Urology | $267 | $267 | $267 |
| Cystourethroscopy with dilation of ureteral stricture CPT 52260 • Urology | $228 | $228 | $228 |
| Cystourethroscopy with ureteral stent insertion CPT 52332 • Urology | $183 | $183 | $183 |
| Cystourethroscopy with lithotripsy CPT 52353 • Urology | $424 | $424 | $424 |
| TURP transurethral resection of prostate CPT 52601 • Urology | $859 | $859 | $859 |
| Orchiectomy radical inguinal CPT 54530 • Urology | $569 | $569 | $569 |
| Vasectomy CPT 55250 • Urology | $378 | $378 | $378 |