| Allergen specific IgE each allergen CPT 86003 • Allergy | $5 | $5 | $5 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $8 | $8 | $8 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $4 | $4 |
| Allergy testing insect venoms CPT 95017 • Allergy | $9 | $9 | $9 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $7 | $7 | $7 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $1 | $4 | $7 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $9 | $9 | $10 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $10 | $11 | $11 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $12 | $13 | $15 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $137 | $137 | $137 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $564 | $564 | $564 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $994 | $994 | $994 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,022 | $2,022 | $2,022 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,375 | $2,375 | $2,375 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,641 | $2,641 | $2,641 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $519 | $519 | $519 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $485 | $531 | $578 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $14 | $14 | $14 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $4 | $5 | $6 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $8 | $8 |
| Cardiovascular stress test CPT 93015 • Cardiology | $62 | $67 | $71 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $5 | $5 | $5 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $72 | $72 | $72 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $224 | $243 | $261 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $62 | $62 | $62 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $53 | $90 | $127 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $238 | $238 | $238 |
| Stress echocardiography CPT 93350 • Cardiology | $186 | $186 | $186 |
| Left and right heart catheterization CPT 93452 • Cardiology | $233 | $233 | $233 |
| Left heart catheterization CPT 93458 • Cardiology | $251 | $270 | $290 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $285 | $307 | $329 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $136 | $163 | $190 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $12 | $37 | $62 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $178 | $189 | $201 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $138 | $146 | $154 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $78 | $78 | $78 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $90 | $90 | $90 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $42 | $68 | $95 |
| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $86 | $112 | $138 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $171 | $171 | $171 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $38 | $40 | $41 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $100 | $117 | $134 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $42 | $42 | $42 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $51 | $51 | $51 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $141 | $141 | $141 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $66 | $119 | $172 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $73 | $100 | $127 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $117 | $117 | $117 |
| 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 | $163 | $163 | $163 |