| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $3 | $4 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $5 | $5 | $6 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $4 | $4 |
| Allergy testing insect venoms CPT 95017 • Allergy | $9 | $10 | $10 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $22 | $24 | $25 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $1 | $4 | $6 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $14 | $15 | $16 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $17 | $18 | $20 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $4 | $7 | $10 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $587 | $644 | $701 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,022 | $1,124 | $1,227 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,181 | $2,847 | $3,513 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,339 | $3,229 | $4,119 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,473 | $3,521 | $4,568 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $595 | $609 | $622 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $691 | $702 | $713 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $9 | $18 | $28 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $9 | $13 | $18 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $10 | $10 | $11 |
| Cardiovascular stress test CPT 93015 • Cardiology | $54 | $82 | $111 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $54 | $61 | $68 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $45 | $106 | $167 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $366 | $366 | $366 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $100 | $127 | $155 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $80 | $142 | $205 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $174 | $226 | $278 |
| Stress echocardiography CPT 93350 • Cardiology | $71 | $91 | $112 |
| Left and right heart catheterization CPT 93452 • Cardiology | $347 | $656 | $964 |
| Left heart catheterization CPT 93458 • Cardiology | $366 | $399 | $431 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $489 | $907 | $1,325 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $34 | $46 | $58 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $80 | $92 | $104 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $33 | $44 | $55 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $219 | $231 | $243 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $19 | $32 | $45 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $57 | $84 | $111 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $112 | $116 | $119 |
| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $46 | $98 | $149 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $178 | $179 | $181 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $66 | $99 | $132 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $58 | $73 | $87 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $46 | $57 | $68 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $51 | $66 | $81 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $105 | $115 | $124 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $145 | $178 | $211 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $141 | $153 | $166 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $143 | $168 | $194 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $103 | $126 | $149 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $177 | $188 | $199 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $211 | $270 | $329 |