| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $3 | $3 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $4 | $4 | $4 |
| 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 | $21 | $21 | $21 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $1 | $4 | $7 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $9 | $9 | $9 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $10 | $10 | $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 | $595 | $595 | $595 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,047 | $1,047 | $1,047 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,135 | $2,135 | $2,135 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,509 | $2,509 | $2,509 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,798 | $2,798 | $2,798 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $555 | $555 | $555 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $485 | $551 | $617 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $14 | $20 | $29 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $4 | $6 | $8 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $8 | $9 |
| Cardiovascular stress test CPT 93015 • Cardiology | $62 | $67 | $72 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $33 | $33 | $33 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $89 | $89 | $89 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $224 | $224 | $224 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $168 | $168 | $168 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $53 | $65 | $77 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $135 | $135 | $135 |
| Stress echocardiography CPT 93350 • Cardiology | $192 | $192 | $192 |
| Left and right heart catheterization CPT 93452 • Cardiology | $920 | $920 | $920 |
| Left heart catheterization CPT 93458 • Cardiology | $251 | $665 | $1,079 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $285 | $318 | $351 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $136 | $147 | $159 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $62 | $67 | $72 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $178 | $196 | $213 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $36 | $87 | $138 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $70 | $70 | $70 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $27 | $27 | $27 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $95 | $103 | $111 |
| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $56 | $71 | $86 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $169 | $169 | $169 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $40 | $40 | $41 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $60 | $80 | $100 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $45 | $45 | $45 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $129 | $129 | $129 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $140 | $140 | $140 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $66 | $92 | $117 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $73 | $131 | $189 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $155 | $155 | $155 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $137 | $137 | $137 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $256 | $256 | $256 |