| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $170 | $170 | $170 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $139 | $139 | $139 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $1,450 | $1,450 | $1,450 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $8,058 | $8,058 | $8,058 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $5,590 | $5,590 | $5,590 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $11,206 | $11,206 | $11,206 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $14 | $14 | $14 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $8 | $8 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $59 | $59 | $59 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $66 | $66 | $66 |
| Left and right heart catheterization CPT 93452 • Cardiology | $2,516 | $2,516 | $2,516 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $2,516 | $2,516 | $2,516 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $16 | $16 | $16 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $38 | $38 | $38 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $171 | $171 | $171 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $60 | $60 | $60 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $31 | $97 | $163 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $78 | $78 | $78 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $78 | $78 | $78 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $253 | $253 | $253 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $212 | $212 | $212 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $159 | $159 | $159 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $78 | $78 | $78 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $133 | $133 | $133 |
| Septoplasty CPT 30520 • ENT | $1,858 | $1,858 | $1,858 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $58 | $58 | $58 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $2,694 | $2,694 | $2,694 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $2,694 | $2,694 | $2,694 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $2,694 | $2,694 | $2,694 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $2,209 | $2,209 | $2,209 |
| Tympanostomy tube insertion CPT 69436 • ENT | $1,542 | $1,542 | $1,542 |
| Comprehensive audiometry evaluation CPT 92557 • ENT | $34 | $34 | $34 |
| Incision and drainage abscess complicated CPT 10061 • Emergency | $126 | $152 | $178 |
| Simple wound repair face 2.5cm or less CPT 12011 • Emergency | $106 | $106 | $106 |
| Intermediate wound repair 2.5cm or less CPT 12031 • Emergency | $249 | $249 | $249 |
| Emergency department visit low severity CPT 99282 • Emergency | $43 | $43 | $43 |
| Emergency department visit moderate severity CPT 99283 • Emergency | $74 | $74 | $74 |
| Emergency department visit high severity CPT 99284 • Emergency | $166 | $166 | $166 |
| Emergency department visit highest severity CPT 99285 • Emergency | $233 | $233 | $233 |
| Critical care first 30-74 minutes CPT 99291 • Emergency | $216 | $216 | $216 |
| Critical care each additional 30 minutes CPT 99292 • Emergency | $142 | $142 | $142 |
| Esophagoscopy rigid diagnostic CPT 43191 • Gastroenterology | $815 | $815 | $815 |
| Upper GI endoscopy with biopsy CPT 43239 • Gastroenterology | $87 | $418 | $750 |
| Upper GI endoscopy with foreign body removal CPT 43247 • Gastroenterology | $750 | $750 | $750 |
| Upper GI endoscopy with balloon dilation CPT 43249 • Gastroenterology | $1,124 | $1,124 | $1,124 |
| ERCP diagnostic CPT 43260 • Gastroenterology | $2,192 | $2,192 | $2,192 |
| ERCP with removal of stones CPT 43264 • Gastroenterology | $182 | $1,187 | $2,192 |
| Colonoscopy through stoma with biopsy CPT 44389 • Gastroenterology | $832 | $832 | $832 |
| Colonoscopy diagnostic CPT 45378 • Gastroenterology | $233 | $233 | $233 |
| Colonoscopy with submucosal injection CPT 45381 • Gastroenterology | $832 | $832 | $832 |