| 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 |
| Polysomnography age 6 or older CPT 95810 • Sleep Medicine | $450 | $450 | $450 |
| Polysomnography with CPAP titration CPT 95811 • Sleep Medicine | $384 | $384 | $384 |
| Respiratory assist device BiPAP without backup HCPCS E0470 • Sleep Medicine | $196 | $196 | $196 |
| CPAP device continuous positive airway pressure HCPCS E0601 • Sleep Medicine | $70 | $70 | $70 |
| Laparoscopic partial nephrectomy CPT 50543 • Urology | $1,596 | $1,596 | $1,596 |
| Laparoscopic radical nephrectomy CPT 50545 • Urology | $1,428 | $1,428 | $1,428 |
| Lithotripsy extracorporeal shock wave (ESWL) CPT 50590 • Urology | $618 | $618 | $618 |
| Complex uroflowmetry CPT 51741 • Urology | $4 | $4 | $4 |
| Post-void residual urine measurement CPT 51798 • Urology | $5 | $5 | $5 |
| Cystourethroscopy diagnostic CPT 52000 • Urology | $57 | $57 | $57 |
| Cystourethroscopy with tumor fulguration small CPT 52234 • Urology | $110 | $110 | $110 |
| Cystourethroscopy with tumor fulguration medium CPT 52235 • Urology | $129 | $129 | $129 |
| Cystourethroscopy with dilation of ureteral stricture CPT 52260 • Urology | $149 | $149 | $149 |
| Cystourethroscopy with ureteral stent insertion CPT 52332 • Urology | $288 | $288 | $288 |
| Cystourethroscopy with lithotripsy CPT 52353 • Urology | $277 | $277 | $277 |
| TURP transurethral resection of prostate CPT 52601 • Urology | $783 | $783 | $783 |
| Laser vaporization of prostate CPT 52648 • Urology | $747 | $747 | $747 |
| Circumcision CPT 54150 • Urology | $43 | $43 | $43 |
| Orchiectomy simple CPT 54520 • Urology | $150 | $150 | $150 |
| Orchiectomy radical inguinal CPT 54530 • Urology | $232 | $232 | $232 |
| Vasectomy CPT 55250 • Urology | $105 | $105 | $105 |
| Radical prostatectomy retropubic CPT 55840 • Urology | $527 | $527 | $527 |
| Laparoscopic radical prostatectomy CPT 55866 • Urology | $137 | $137 | $137 |