| Allergen specific IgE each allergen CPT 86003 • Allergy | $2 | $2 | $2 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $4 | $4 | $4 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $10 | $10 | $10 |
| Allergy testing insect venoms CPT 95017 • Allergy | $22 | $22 | $22 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $55 | $55 | $55 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $22 | $22 | $22 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $24 | $24 | $24 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $29 | $29 | $29 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $41 | $41 | $41 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $1,387 | $1,387 | $1,387 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $2,445 | $2,445 | $2,445 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $4,968 | $4,968 | $4,968 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $5,832 | $5,832 | $5,832 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $6,500 | $6,500 | $6,500 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $1,395 | $1,395 | $1,395 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $1,552 | $1,552 | $1,552 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $39 | $39 | $39 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $17 | $17 | $17 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $22 | $22 | $22 |
| Cardiovascular stress test CPT 93015 • Cardiology | $185 | $185 | $185 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $88 | $88 | $88 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $204 | $204 | $204 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $604 | $604 | $604 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $187 | $265 | $343 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $358 | $358 | $358 |
| Stress echocardiography CPT 93350 • Cardiology | $502 | $502 | $502 |
| Left and right heart catheterization CPT 93452 • Cardiology | $1,858 | $1,858 | $1,858 |
| Left heart catheterization CPT 93458 • Cardiology | $2,097 | $2,097 | $2,097 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $882 | $882 | $882 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $103 | $258 | $413 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $186 | $203 | $220 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $555 | $555 | $555 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $89 | $297 | $506 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $183 | $183 | $183 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $210 | $210 | $210 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $273 | $273 | $273 |
| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $341 | $341 | $341 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $417 | $417 | $417 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $270 | $270 | $270 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $328 | $328 | $328 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $285 | $285 | $285 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $312 | $312 | $312 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $339 | $339 | $339 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $413 | $413 | $413 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $456 | $456 | $456 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $379 | $379 | $379 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $530 | $530 | $530 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $611 | $611 | $611 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $653 | $653 | $653 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $544 | $544 | $544 |