| Permanent pacemaker insertion CPT 33208 • Cardiology | $2,000 | $5,130 | $8,259 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $2,000 | $11,117 | $26,771 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,000 | $2,000 | $2,000 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,000 | $2,000 | $2,000 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,000 | $2,000 | $2,000 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $2,000 | $3,023 | $3,897 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $2,000 | $4,180 | $6,360 |
| Left and right heart catheterization CPT 93452 • Cardiology | $1,428 | $1,735 | $2,000 |
| Left heart catheterization CPT 93458 • Cardiology | $1,778 | $1,889 | $2,000 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $1,428 | $1,735 | $2,000 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $425 | $425 | $425 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $34 | $230 | $425 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $78 | $198 | $425 |
| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $96 | $260 | $425 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $120 | $272 | $425 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $44 | $1,022 | $2,000 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $44 | $1,022 | $2,000 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $2,000 | $2,000 | $2,000 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $88 | $1,044 | $2,000 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $98 | $261 | $425 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $112 | $269 | $425 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $123 | $274 | $425 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $108 | $341 | $575 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $141 | $283 | $425 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $157 | $291 | $425 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $144 | $246 | $425 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $121 | $281 | $575 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $425 | $425 | $425 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $425 | $425 | $425 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $425 | $425 | $425 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $90 | $212 | $425 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $44 | $235 | $425 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $75 | $250 | $425 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $425 | $425 | $425 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $575 | $1,036 | $1,498 |
| Septoplasty CPT 30520 • ENT | $900 | $1,151 | $1,498 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $425 | $566 | $706 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $112 | $344 | $575 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $575 | $713 | $851 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $900 | $1,679 | $2,606 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $2,000 | $2,303 | $2,606 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $1,730 | $1,865 | $2,000 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $1,531 | $2,045 | $2,606 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $1,531 | $2,045 | $2,606 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $133 | $279 | $425 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $2,000 | $2,567 | $3,134 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $1,255 | $1,584 | $2,000 |
| Tonsillectomy primary under age 12 CPT 42826 • ENT | $900 | $1,199 | $1,498 |
| Adenoidectomy primary under age 12 CPT 42830 • ENT | $900 | $1,199 | $1,498 |
| Removal impacted cerumen unilateral CPT 69210 • ENT | $425 | $425 | $425 |