| Permanent pacemaker insertion CPT 33208 • Cardiology | $7,254 | $7,254 | $7,254 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $3,663 | $13,587 | $23,511 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $3,021 | $3,222 | $3,422 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $6,057 | $6,327 | $6,598 |
| Left and right heart catheterization CPT 93452 • Cardiology | $1,360 | $1,461 | $1,562 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $1,360 | $1,461 | $1,562 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $27 | $27 | $27 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $68 | $71 | $74 |
| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $84 | $84 | $84 |
| 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 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $86 | $86 | $86 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $99 | $99 | $99 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $108 | $108 | $108 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $95 | $95 | $95 |
| 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 15 or more CPT 17004 • Dermatology | $72 | $89 | $106 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $35 | $35 | $35 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $60 | $60 | $60 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $1,315 | $1,315 | $1,315 |
| Septoplasty CPT 30520 • ENT | $1,004 | $1,160 | $1,315 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $99 | $99 | $99 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $747 | $747 | $747 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $1,225 | $1,756 | $2,288 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $2,288 | $2,288 | $2,288 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $1,225 | $1,225 | $1,225 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $1,225 | $1,756 | $2,288 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $117 | $117 | $117 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $2,752 | $2,752 | $2,752 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $1,004 | $1,160 | $1,315 |
| Tonsillectomy primary under age 12 CPT 42826 • ENT | $1,315 | $1,315 | $1,315 |
| Tympanostomy tube insertion CPT 69436 • ENT | $620 | $660 | $701 |
| Tympanoplasty without mastoidectomy CPT 69631 • ENT | $2,752 | $2,752 | $2,752 |
| Tympanoplasty with mastoidectomy CPT 69633 • ENT | $2,752 | $2,752 | $2,752 |
| Incision and drainage abscess complicated CPT 10061 • Emergency | $57 | $85 | $113 |
| 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 | $142 | $170 |
| Intermediate wound repair face 2.5cm or less CPT 12051 • Emergency | $177 | $177 | $177 |
| Esophagoscopy rigid diagnostic CPT 43191 • Gastroenterology | $370 | $593 | $815 |
| Upper GI endoscopy diagnostic CPT 43235 • Gastroenterology | $475 | $475 | $475 |
| Upper GI endoscopy with biopsy CPT 43239 • Gastroenterology | $341 | $408 | $475 |
| Upper GI endoscopy with foreign body removal CPT 43247 • Gastroenterology | $341 | $341 | $341 |
| Upper GI endoscopy with balloon dilation CPT 43249 • Gastroenterology | $511 | $511 | $511 |
| Upper GI endoscopy with endoscopic ultrasound CPT 43259 • Gastroenterology | $815 | $815 | $815 |
| ERCP diagnostic CPT 43260 • Gastroenterology | $997 | $1,383 | $1,769 |
| ERCP with sphincterotomy CPT 43262 • Gastroenterology | $1,769 | $1,769 | $1,769 |