| Allergen specific IgE each allergen CPT 86003 • Allergy | $7 | $7 | $7 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $11 | $11 | $11 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $15 | $15 | $15 |
| Allergy testing insect venoms CPT 95017 • Allergy | $20 | $20 | $20 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $18 | $18 | $18 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $2 | $2 | $2 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $21 | $21 | $21 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $25 | $25 | $25 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $31 | $31 | $31 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $2,874 | $2,874 | $2,874 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $4,991 | $4,991 | $4,991 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $10,308 | $10,308 | $10,308 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $12,121 | $12,121 | $12,121 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $13,514 | $13,514 | $13,514 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $1,782 | $1,782 | $1,782 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $1,978 | $1,978 | $1,978 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $41 | $41 | $41 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $19 | $19 | $19 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $21 | $21 | $21 |
| Cardiovascular stress test CPT 93015 • Cardiology | $242 | $242 | $242 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $121 | $121 | $121 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $289 | $289 | $289 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $535 | $535 | $535 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $543 | $543 | $543 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $723 | $723 | $723 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $347 | $347 | $347 |
| Stress echocardiography CPT 93350 • Cardiology | $764 | $764 | $764 |
| Left and right heart catheterization CPT 93452 • Cardiology | $1,932 | $1,932 | $1,932 |
| Left heart catheterization CPT 93458 • Cardiology | $3,389 | $3,389 | $3,389 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $3,744 | $3,744 | $3,744 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $461 | $461 | $461 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $214 | $214 | $214 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $494 | $494 | $494 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $453 | $453 | $453 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $126 | $126 | $126 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $154 | $154 | $154 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $214 | $230 | $263 |
| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $269 | $290 | $330 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $326 | $347 | $400 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $251 | $251 | $251 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $145 | $145 | $145 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $108 | $108 | $108 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $295 | $295 | $295 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $213 | $213 | $213 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $390 | $390 | $390 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $434 | $434 | $434 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $355 | $355 | $355 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $506 | $506 | $506 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $599 | $599 | $599 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $439 | $439 | $439 |