| Implantable defibrillator insertion CPT 33249 • Cardiology | $7,362 | $7,362 | $7,362 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $5,046 | $5,046 | $5,046 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $10,116 | $10,116 | $10,116 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $12 | $12 | $12 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $4 | $4 | $4 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $7 | $7 | $7 |
| Left and right heart catheterization CPT 93452 • Cardiology | $2,271 | $2,271 | $2,271 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $2,271 | $2,271 | $2,271 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $117 | $117 | $117 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $57 | $57 | $57 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $173 | $173 | $173 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $135 | $135 | $135 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $51 | $362 | $673 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $55 | $262 | $673 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $85 | $302 | $673 |
| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $106 | $389 | $673 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $673 | $673 | $673 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $71 | $71 | $71 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $71 | $71 | $71 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $673 | $673 | $673 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $67 | $370 | $673 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $88 | $380 | $673 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $828 | $828 | $828 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $673 | $673 | $673 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $673 | $673 | $673 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $107 | $337 | $673 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $194 | $511 | $828 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $85 | $379 | $673 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $59 | $366 | $673 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $6 | $339 | $673 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $145 | $330 | $673 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $71 | $286 | $673 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $114 | $303 | $673 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $673 | $673 | $673 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $80 | $80 | $80 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $96 | $96 | $96 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $22 | $22 | $22 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $11 | $11 | $11 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $121 | $121 | $121 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $36 | $36 | $36 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $514 | $671 | $828 |
| Septoplasty CPT 30520 • ENT | $725 | $1,201 | $1,677 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $383 | $528 | $673 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $828 | $828 | $828 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $514 | $671 | $828 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $587 | $1,524 | $2,461 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $825 | $825 | $825 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $587 | $587 | $587 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $587 | $1,524 | $2,461 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $587 | $1,524 | $2,461 |