| Allergen specific IgE each allergen CPT 86003 • Allergy | $5 | $5 | $5 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $5 | $5 | $5 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $4 | $4 |
| Allergy testing insect venoms CPT 95017 • Allergy | $11 | $11 | $11 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $9 | $9 | $9 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $6 | $6 | $6 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $16 | $16 | $16 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $21 | $21 | $21 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $4 | $4 | $4 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $612 | $612 | $612 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,065 | $1,065 | $1,065 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,272 | $2,272 | $2,272 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,436 | $2,436 | $2,436 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,576 | $2,576 | $2,576 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $650 | $650 | $650 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $722 | $722 | $722 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $29 | $29 | $29 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $19 | $19 | $19 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $10 | $10 | $10 |
| Cardiovascular stress test CPT 93015 • Cardiology | $116 | $116 | $116 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $71 | $71 | $71 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $175 | $175 | $175 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $77 | $77 | $77 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $84 | $84 | $84 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $130 | $130 | $130 |
| Stress echocardiography CPT 93350 • Cardiology | $75 | $75 | $75 |
| Left and right heart catheterization CPT 93452 • Cardiology | $1,008 | $1,008 | $1,008 |
| Left heart catheterization CPT 93458 • Cardiology | $1,254 | $1,254 | $1,254 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $431 | $431 | $431 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $261 | $261 | $261 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $108 | $108 | $108 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $275 | $275 | $275 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $254 | $254 | $254 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $46 | $46 | $46 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $41 | $41 | $41 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $51 | $51 | $51 |
| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $156 | $156 | $156 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $188 | $188 | $188 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $34 | $34 | $34 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $90 | $90 | $90 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $46 | $46 | $46 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $50 | $50 | $50 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $81 | $81 | $81 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $106 | $106 | $106 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $123 | $123 | $123 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $149 | $149 | $149 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $180 | $180 | $180 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $142 | $142 | $142 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $220 | $220 | $220 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $183 | $183 | $183 |