| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $5 | $5 | $5 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $7,226 | $7,226 | $7,226 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $3,663 | $13,542 | $23,420 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $3,021 | $3,215 | $3,409 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $6,057 | $6,057 | $6,057 |
| 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 | $1,458 | $1,556 |
| Left heart catheterization CPT 93458 • Cardiology | $1,556 | $1,556 | $1,556 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $1,360 | $1,458 | $1,556 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $27 | $27 | $27 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $68 | $94 | $141 |
| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $84 | $131 | $179 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $105 | $105 | $105 |
| 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 | $77 | $77 | $77 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $85 | $85 | $85 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $98 | $98 | $98 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $107 | $107 | $107 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $94 | $94 | $94 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $124 | $124 | $124 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $138 | $138 | $138 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $115 | $131 | $147 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $96 | $112 | $128 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $99 | $99 | $99 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $72 | $89 | $105 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $35 | $99 | $162 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $60 | $60 | $60 |
| Septoplasty CPT 30520 • ENT | $1,004 | $1,157 | $1,310 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $488 | $488 | $488 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $1,225 | $1,225 | $1,225 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $2,279 | $2,279 | $2,279 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $1,513 | $1,513 | $1,513 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $1,225 | $1,752 | $2,279 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $1,225 | $1,752 | $2,279 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $117 | $117 | $117 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $1,004 | $1,157 | $1,310 |
| Tympanostomy tube insertion CPT 69436 • ENT | $618 | $659 | $701 |
| Tympanoplasty with mastoidectomy CPT 69633 • ENT | $2,741 | $2,741 | $2,741 |
| Incision and drainage abscess simple CPT 10060 • Emergency | $76 | $76 | $76 |
| Incision and drainage abscess complicated CPT 10061 • Emergency | $57 | $57 | $57 |
| Simple wound repair face 2.5cm or less CPT 12011 • Emergency | $48 | $48 | $48 |
| Intermediate wound repair 2.5cm or less CPT 12031 • Emergency | $113 | $141 | $170 |
| Esophagoscopy rigid diagnostic CPT 43191 • Gastroenterology | $370 | $591 | $812 |
| Upper GI endoscopy diagnostic CPT 43235 • Gastroenterology | $473 | $473 | $473 |
| Upper GI endoscopy with biopsy CPT 43239 • Gastroenterology | $341 | $407 | $473 |
| Upper GI endoscopy with foreign body removal CPT 43247 • Gastroenterology | $341 | $407 | $473 |
| Upper GI endoscopy with balloon dilation CPT 43249 • Gastroenterology | $511 | $662 | $812 |
| Upper GI endoscopy with polypectomy by snare CPT 43251 • Gastroenterology | $812 | $812 | $812 |