| Permanent pacemaker insertion CPT 33208 • Cardiology | $641 | $641 | $641 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $26 | $26 | $26 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,376 | $2,376 | $2,376 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,735 | $2,735 | $2,735 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $26 | $26 | $26 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $28 | $28 | $28 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $64 | $64 | $64 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $33 | $33 | $33 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $97 | $97 | $97 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $26 | $26 | $26 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $26 | $26 | $26 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $120 | $120 | $120 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $26 | $26 | $26 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $167 | $167 | $167 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $26 | $26 | $26 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $185 | $185 | $185 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $26 | $26 | $26 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $251 | $251 | $251 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $26 | $26 | $26 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $71 | $71 | $71 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $26 | $26 | $26 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $5 | $5 | $5 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $26 | $26 | $26 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $113 | $113 | $113 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $134 | $134 | $134 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $455 | $455 | $455 |
| Septoplasty CPT 30520 • ENT | $645 | $645 | $645 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $26 | $26 | $26 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $87 | $87 | $87 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $351 | $351 | $351 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $326 | $326 | $326 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $485 | $485 | $485 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $236 | $236 | $236 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $381 | $381 | $381 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $611 | $611 | $611 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $149 | $149 | $149 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $326 | $326 | $326 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $26 | $26 | $26 |
| Tonsillectomy primary under age 12 CPT 42826 • ENT | $282 | $282 | $282 |
| Adenoidectomy primary under age 12 CPT 42830 • ENT | $228 | $228 | $228 |
| Removal impacted cerumen unilateral CPT 69210 • ENT | $54 | $54 | $54 |
| Tympanostomy tube insertion CPT 69436 • ENT | $182 | $182 | $182 |
| Tympanoplasty without mastoidectomy CPT 69631 • ENT | $26 | $26 | $26 |
| Tympanoplasty with mastoidectomy CPT 69633 • ENT | $1,134 | $1,134 | $1,134 |
| Comprehensive audiometry evaluation CPT 92557 • ENT | $56 | $56 | $56 |
| Incision and drainage abscess simple CPT 10060 • Emergency | $118 | $118 | $118 |
| Incision and drainage abscess complicated CPT 10061 • Emergency | $26 | $26 | $26 |
| Simple wound repair up to 2.5cm CPT 12001 • Emergency | $26 | $26 | $26 |
| Simple wound repair 2.6-7.5cm CPT 12002 • Emergency | $26 | $26 | $26 |
| Simple wound repair face 2.5cm or less CPT 12011 • Emergency | $167 | $167 | $167 |