| Permanent pacemaker insertion CPT 33208 • Cardiology | $9,349 | $9,349 | $9,349 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $5,677 | $17,990 | $30,303 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $3,021 | $3,716 | $4,411 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $6,057 | $7,280 | $8,504 |
| Left and right heart catheterization CPT 93452 • Cardiology | $1,360 | $1,686 | $2,013 |
| Left heart catheterization CPT 93458 • Cardiology | $2,013 | $2,013 | $2,013 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $1,360 | $1,360 | $1,360 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $42 | $42 | $42 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $88 | $101 | $115 |
| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $109 | $109 | $109 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $55 | $55 | $55 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $55 | $55 | $55 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $100 | $100 | $100 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $111 | $111 | $111 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $127 | $127 | $127 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $139 | $139 | $139 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $122 | $122 | $122 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $160 | $160 | $160 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $178 | $178 | $178 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $178 | $184 | $190 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $150 | $158 | $166 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $112 | $124 | $136 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $55 | $55 | $55 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $94 | $94 | $94 |
| Septoplasty CPT 30520 • ENT | $1,004 | $1,350 | $1,695 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $799 | $799 | $799 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $127 | $127 | $127 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $963 | $963 | $963 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $1,898 | $2,424 | $2,949 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $1,958 | $1,958 | $1,958 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $1,898 | $2,424 | $2,949 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $1,898 | $1,898 | $1,898 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $151 | $151 | $151 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $3,547 | $3,547 | $3,547 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $1,557 | $1,557 | $1,557 |
| Tonsillectomy primary under age 12 CPT 42826 • ENT | $1,695 | $1,695 | $1,695 |
| Tympanostomy tube insertion CPT 69436 • ENT | $799 | $943 | $1,086 |
| Tympanoplasty without mastoidectomy CPT 69631 • ENT | $3,547 | $3,547 | $3,547 |
| Incision and drainage abscess complicated CPT 10061 • Emergency | $89 | $89 | $89 |
| Simple wound repair face 2.5cm or less CPT 12011 • Emergency | $75 | $75 | $75 |
| Intermediate wound repair 2.5cm or less CPT 12031 • Emergency | $176 | $197 | $219 |
| Intermediate wound repair face 2.5cm or less CPT 12051 • Emergency | $228 | $228 | $228 |
| Esophagoscopy rigid diagnostic CPT 43191 • Gastroenterology | $574 | $574 | $574 |
| Upper GI endoscopy diagnostic CPT 43235 • Gastroenterology | $612 | $612 | $612 |
| Upper GI endoscopy with biopsy CPT 43239 • Gastroenterology | $529 | $584 | $612 |
| Upper GI endoscopy with foreign body removal CPT 43247 • Gastroenterology | $529 | $584 | $612 |
| Upper GI endoscopy with balloon dilation CPT 43249 • Gastroenterology | $792 | $964 | $1,051 |
| Upper GI endoscopy with polypectomy by snare CPT 43251 • Gastroenterology | $1,050 | $1,050 | $1,050 |
| Upper GI endoscopy with stent placement CPT 43257 • Gastroenterology | $2,895 | $2,895 | $2,895 |
| Upper GI endoscopy with endoscopic ultrasound CPT 43259 • Gastroenterology | $1,051 | $1,051 | $1,051 |