| Permanent pacemaker insertion CPT 33208 • Cardiology | $1,645 | $6,358 | $16,026 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,811 | $17,621 | $48,756 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $57 | $265 | $328 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $57 | $265 | $328 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $57 | $249 | $328 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $328 | $3,062 | $7,097 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $328 | $5,312 | $13,682 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $14 | $14 | $14 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $9 | $9 | $9 |
| Cardiovascular stress test CPT 93015 • Cardiology | $64 | $64 | $64 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $153 | $153 | $153 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $98 | $98 | $98 |
| Left and right heart catheterization CPT 93452 • Cardiology | $1,200 | $2,034 | $3,239 |
| Left heart catheterization CPT 93458 • Cardiology | $328 | $1,644 | $3,239 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $1,200 | $1,997 | $3,239 |
| Unlisted dental procedure CPT 41899 • Dental | $106 | $106 | $106 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $57 | $238 | $350 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $53 | $179 | $350 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $36 | $166 | $350 |
| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $57 | $196 | $350 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $57 | $279 | $350 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $57 | $184 | $328 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $57 | $202 | $328 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $57 | $229 | $328 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $57 | $218 | $328 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $178 | $2,505 | $13,476 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $106 | $2,469 | $13,476 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $65 | $2,465 | $13,476 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $196 | $2,789 | $13,476 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $258 | $2,522 | $13,476 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $287 | $2,958 | $13,476 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $106 | $2,166 | $13,476 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $186 | $2,585 | $13,476 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $57 | $238 | $350 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $57 | $238 | $350 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $57 | $238 | $350 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $57 | $221 | $350 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $57 | $195 | $350 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $57 | $222 | $350 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $97 | $97 | $97 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $350 | $350 | $350 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $50 | $50 | $50 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $34 | $34 | $34 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $81 | $81 | $81 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $23 | $23 | $23 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $850 | $5,801 | $28,516 |
| Septoplasty CPT 30520 • ENT | $850 | $6,873 | $33,816 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $328 | $4,473 | $19,682 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $57 | $513 | $904 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $721 | $5,583 | $28,516 |