| Allergen specific IgE each allergen CPT 86003 • Allergy | $4 | $4 | $4 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $6 | $6 | $6 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $4 | $4 |
| Allergy testing insect venoms CPT 95017 • Allergy | $7 | $7 | $7 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $18 | $18 | $18 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $5 | $5 | $5 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $9 | $9 | $9 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $11 | $11 | $11 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $2 | $2 | $2 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $440 | $440 | $440 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $763 | $763 | $763 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $1,574 | $1,574 | $1,574 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $1,816 | $1,816 | $1,816 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,001 | $2,001 | $2,001 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $511 | $511 | $511 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $567 | $567 | $567 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $19 | $19 | $19 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $12 | $12 | $12 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $7 | $7 | $7 |
| Cardiovascular stress test CPT 93015 • Cardiology | $87 | $87 | $87 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $53 | $53 | $53 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $115 | $115 | $115 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $144 | $144 | $144 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $184 | $184 | $184 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $169 | $169 | $169 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $168 | $168 | $168 |
| Stress echocardiography CPT 93350 • Cardiology | $67 | $67 | $67 |
| Left and right heart catheterization CPT 93452 • Cardiology | $791 | $791 | $791 |
| Left heart catheterization CPT 93458 • Cardiology | $301 | $301 | $301 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $1,088 | $1,088 | $1,088 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $186 | $186 | $186 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $103 | $103 | $103 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $236 | $236 | $236 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $212 | $212 | $212 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $36 | $36 | $36 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $44 | $44 | $44 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $37 | $37 | $37 |
| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $112 | $112 | $112 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $56 | $56 | $56 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $51 | $51 | $51 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $68 | $68 | $68 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $29 | $29 | $29 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $62 | $62 | $62 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $89 | $89 | $89 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $74 | $74 | $74 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $82 | $82 | $82 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $74 | $74 | $74 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $135 | $135 | $135 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $161 | $161 | $161 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $116 | $116 | $116 |