| Allergen specific IgE each allergen CPT 86003 • Allergy | $5 | $5 | $5 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $4 | $4 | $4 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $5 | $5 | $5 |
| Allergy testing insect venoms CPT 95017 • Allergy | $5 | $5 | $5 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $9 | $9 | $9 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $1 | $1 | $1 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $12 | $12 | $12 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $14 | $14 | $14 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $19 | $19 | $19 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $660 | $660 | $660 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,164 | $1,164 | $1,164 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,364 | $2,364 | $2,364 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,776 | $2,776 | $2,776 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $3,091 | $3,091 | $3,091 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $669 | $669 | $669 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $745 | $745 | $745 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $18 | $18 | $18 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $5 | $5 | $5 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $11 | $11 | $11 |
| Cardiovascular stress test CPT 93015 • Cardiology | $89 | $89 | $89 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $43 | $43 | $43 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $94 | $94 | $94 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $143 | $143 | $143 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $283 | $283 | $283 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $162 | $162 | $162 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $305 | $305 | $305 |
| Stress echocardiography CPT 93350 • Cardiology | $150 | $150 | $150 |
| Left and right heart catheterization CPT 93452 • Cardiology | $1,177 | $1,177 | $1,177 |
| Left heart catheterization CPT 93458 • Cardiology | $373 | $373 | $373 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $1,456 | $1,456 | $1,456 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $193 | $193 | $193 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $87 | $87 | $87 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $257 | $257 | $257 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $238 | $238 | $238 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $91 | $91 | $91 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $29 | $29 | $29 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $48 | $48 | $48 |
| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $59 | $59 | $59 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $199 | $199 | $199 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $129 | $129 | $129 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $65 | $65 | $65 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $49 | $49 | $49 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $58 | $58 | $58 |
| 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 | $198 | $198 | $198 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $218 | $218 | $218 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $182 | $182 | $182 |
| 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 | $187 | $187 | $187 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $203 | $203 | $203 |