| Allergen specific IgE each allergen CPT 86003 • Allergy | $4 | $4 | $4 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $5 | $5 | $5 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $8 | $8 | $8 |
| Allergy testing insect venoms CPT 95017 • Allergy | $6 | $6 | $6 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $35 | $35 | $35 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $10 | $10 | $10 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $14 | $14 | $14 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $17 | $17 | $17 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $5 | $5 | $5 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $833 | $833 | $833 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,447 | $1,447 | $1,447 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,929 | $2,929 | $2,929 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $3,436 | $3,436 | $3,436 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $3,828 | $3,828 | $3,828 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $860 | $860 | $860 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $955 | $955 | $955 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $30 | $30 | $30 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $16 | $16 | $16 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $14 | $14 | $14 |
| Cardiovascular stress test CPT 93015 • Cardiology | $140 | $140 | $140 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $78 | $78 | $78 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $158 | $158 | $158 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $202 | $202 | $202 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $249 | $249 | $249 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $293 | $293 | $293 |
| Stress echocardiography CPT 93350 • Cardiology | $307 | $307 | $307 |
| Left and right heart catheterization CPT 93452 • Cardiology | $412 | $412 | $412 |
| Left heart catheterization CPT 93458 • Cardiology | $506 | $506 | $506 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $570 | $570 | $570 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $47 | $47 | $47 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $173 | $173 | $173 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $45 | $45 | $45 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $357 | $357 | $357 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $32 | $32 | $32 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $81 | $81 | $81 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $62 | $62 | $62 |
| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $190 | $190 | $190 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $95 | $95 | $95 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $44 | $44 | $44 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $75 | $75 | $75 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $96 | $96 | $96 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $117 | $117 | $117 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $162 | $162 | $162 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $199 | $199 | $199 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $158 | $158 | $158 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $139 | $139 | $139 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $251 | $251 | $251 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $211 | $211 | $211 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $232 | $232 | $232 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $174 | $174 | $174 |