| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $5 | $5 | $5 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $7,447 | $7,447 | $7,447 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $3,663 | $13,900 | $24,137 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $3,021 | $3,267 | $3,513 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $6,057 | $6,415 | $6,773 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $21 | $21 | $21 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $10 | $10 | $10 |
| Left and right heart catheterization CPT 93452 • Cardiology | $1,360 | $1,482 | $1,603 |
| Left heart catheterization CPT 93458 • Cardiology | $1,603 | $1,603 | $1,603 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $1,360 | $1,482 | $1,603 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $27 | $27 | $27 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $70 | $95 | $141 |
| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $86 | $133 | $179 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $108 | $108 | $108 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $35 | $35 | $35 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $35 | $35 | $35 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $79 | $79 | $79 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $88 | $88 | $88 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $101 | $101 | $101 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $111 | $111 | $111 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $97 | $97 | $97 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $127 | $127 | $127 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $142 | $142 | $142 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $115 | $133 | $151 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $96 | $114 | $132 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $99 | $99 | $99 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $72 | $90 | $109 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $35 | $99 | $162 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $60 | $60 | $60 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $1,350 | $1,350 | $1,350 |
| Septoplasty CPT 30520 • ENT | $1,004 | $1,177 | $1,350 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $637 | $637 | $637 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $101 | $101 | $101 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $488 | $628 | $767 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $1,225 | $1,787 | $2,349 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $2,349 | $2,349 | $2,349 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $1,559 | $1,559 | $1,559 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $1,225 | $1,787 | $2,349 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $1,225 | $1,787 | $2,349 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $120 | $120 | $120 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $2,825 | $2,825 | $2,825 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $1,004 | $1,177 | $1,350 |
| Tonsillectomy primary under age 12 CPT 42826 • ENT | $1,350 | $1,350 | $1,350 |
| Adenoidectomy primary under age 12 CPT 42830 • ENT | $1,350 | $1,350 | $1,350 |
| Tympanostomy tube insertion CPT 69436 • ENT | $637 | $669 | $701 |
| Tympanoplasty without mastoidectomy CPT 69631 • ENT | $2,825 | $2,825 | $2,825 |
| Tympanoplasty with mastoidectomy CPT 69633 • ENT | $2,825 | $2,825 | $2,825 |
| Incision and drainage abscess simple CPT 10060 • Emergency | $78 | $78 | $78 |
| Incision and drainage abscess complicated CPT 10061 • Emergency | $57 | $86 | $116 |
| Simple wound repair face 2.5cm or less CPT 12011 • Emergency | $48 | $48 | $48 |