| Permanent pacemaker insertion CPT 33208 • Cardiology | $522 | $3,186 | $16,026 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $522 | $9,295 | $43,926 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $57 | $419 | $540 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $57 | $419 | $540 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $57 | $395 | $540 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $540 | $1,388 | $3,525 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $540 | $2,206 | $6,796 |
| Left and right heart catheterization CPT 93452 • Cardiology | $540 | $909 | $1,609 |
| Left heart catheterization CPT 93458 • Cardiology | $540 | $909 | $1,609 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $540 | $835 | $1,609 |
| Unlisted dental procedure CPT 41899 • Dental | $81 | $81 | $81 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $50 | $290 | $540 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $50 | $240 | $540 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $57 | $334 | $540 |
| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $57 | $348 | $540 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $57 | $412 | $540 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $50 | $301 | $540 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $50 | $301 | $540 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $50 | $301 | $540 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $50 | $301 | $540 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $273 | $2,618 | $13,476 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $81 | $2,586 | $13,476 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $273 | $3,020 | $13,476 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $273 | $2,632 | $13,476 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $273 | $2,618 | $13,476 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $273 | $3,020 | $13,476 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $81 | $2,586 | $13,476 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $273 | $3,034 | $13,476 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $50 | $301 | $540 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $50 | $290 | $540 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $50 | $301 | $540 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $57 | $350 | $540 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $50 | $301 | $540 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $50 | $301 | $540 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $540 | $540 | $540 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $457 | $5,257 | $28,516 |
| Septoplasty CPT 30520 • ENT | $540 | $7,298 | $33,816 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $341 | $4,286 | $19,682 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $50 | $301 | $540 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $396 | $5,165 | $28,516 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $522 | $9,706 | $45,983 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $540 | $7,678 | $42,765 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $522 | $8,179 | $45,983 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $522 | $8,179 | $45,983 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $522 | $8,179 | $45,983 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $81 | $3,621 | $19,682 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $522 | $8,179 | $45,983 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $540 | $7,678 | $42,765 |
| Tonsillectomy primary under age 12 CPT 42826 • ENT | $540 | $7,298 | $33,816 |
| Adenoidectomy primary under age 12 CPT 42830 • ENT | $540 | $6,171 | $33,816 |