| Permanent pacemaker insertion CPT 33208 • Cardiology | $2,787 | $2,787 | $2,787 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $54 | $54 | $54 |
| Left heart catheterization CPT 93458 • Cardiology | $1,836 | $1,836 | $1,836 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $31 | $31 | $31 |
| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $114 | $114 | $114 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $140 | $140 | $140 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $41 | $41 | $41 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $44 | $44 | $44 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $79 | $79 | $79 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $88 | $88 | $88 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $97 | $97 | $97 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $83 | $83 | $83 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $113 | $113 | $113 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $132 | $132 | $132 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $44 | $44 | $44 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $44 | $44 | $44 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $4 | $4 | $4 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $1,255 | $1,255 | $1,255 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $376 | $376 | $376 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $94 | $94 | $94 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $1,073 | $1,073 | $1,073 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $1,531 | $1,531 | $1,531 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $1,531 | $1,531 | $1,531 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $157 | $157 | $157 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $1,255 | $1,255 | $1,255 |
| Tonsillectomy primary under age 12 CPT 42826 • ENT | $1,255 | $1,255 | $1,255 |
| Adenoidectomy primary under age 12 CPT 42830 • ENT | $1,255 | $1,255 | $1,255 |
| Removal impacted cerumen unilateral CPT 69210 • ENT | $26 | $34 | $43 |
| Tympanoplasty without mastoidectomy CPT 69631 • ENT | $2,272 | $2,272 | $2,272 |
| Tympanoplasty with mastoidectomy CPT 69633 • ENT | $2,272 | $2,272 | $2,272 |
| Incision and drainage abscess simple CPT 10060 • Emergency | $61 | $61 | $61 |
| Simple wound repair up to 2.5cm CPT 12001 • Emergency | $55 | $55 | $55 |
| Simple wound repair 2.6-7.5cm CPT 12002 • Emergency | $60 | $60 | $60 |
| Intermediate wound repair face 2.5cm or less CPT 12051 • Emergency | $152 | $152 | $152 |
| Initial treatment first degree burn CPT 16000 • Emergency | $31 | $31 | $31 |
| Upper GI endoscopy diagnostic CPT 43235 • Gastroenterology | $426 | $426 | $426 |
| Upper GI endoscopy with polypectomy by snare CPT 43251 • Gastroenterology | $639 | $639 | $639 |
| Upper GI endoscopy with stent placement CPT 43257 • Gastroenterology | $1,310 | $1,310 | $1,310 |
| Upper GI endoscopy with endoscopic ultrasound CPT 43259 • Gastroenterology | $106 | $372 | $639 |
| ERCP with sphincterotomy CPT 43262 • Gastroenterology | $1,246 | $1,246 | $1,246 |
| ERCP with removal of stones CPT 43264 • Gastroenterology | $341 | $341 | $341 |
| ERCP with stent placement CPT 43274 • Gastroenterology | $1,442 | $1,442 | $1,442 |
| Colonoscopy through stoma diagnostic CPT 44388 • Gastroenterology | $473 | $473 | $473 |
| Colonoscopy diagnostic CPT 45378 • Gastroenterology | $473 | $473 | $473 |
| Colonoscopy with biopsy CPT 45380 • Gastroenterology | $473 | $473 | $473 |
| Colonoscopy with lesion removal by hot biopsy CPT 45384 • Gastroenterology | $473 | $473 | $473 |
| Colonoscopy with balloon dilation CPT 45386 • Gastroenterology | $473 | $473 | $473 |
| Colonoscopy with ablation of tumor or polyp CPT 45388 • Gastroenterology | $541 | $541 | $541 |
| Auto-added CPT 10120 • General | $83 | $83 | $83 |
| Auto-added CPT 10140 • General | $89 | $89 | $89 |