| Allergen specific IgE each allergen CPT 86003 • Allergy | $4 | $4 | $4 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $6 | $6 | $6 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $7 | $7 | $7 |
| Allergy testing insect venoms CPT 95017 • Allergy | $11 | $11 | $11 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $27 | $27 | $27 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $8 | $8 | $8 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $12 | $12 | $12 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $15 | $15 | $15 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $4 | $9 | $14 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $663 | $663 | $663 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,147 | $1,147 | $1,147 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,331 | $2,331 | $2,331 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,712 | $2,712 | $2,712 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $3,012 | $3,012 | $3,012 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $666 | $666 | $666 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $25 | $25 | $25 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $14 | $14 | $14 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $11 | $11 | $11 |
| Cardiovascular stress test CPT 93015 • Cardiology | $121 | $121 | $121 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $70 | $70 | $70 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $176 | $220 | $263 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $321 | $321 | $321 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $394 | $394 | $394 |
| Stress echocardiography CPT 93350 • Cardiology | $257 | $257 | $257 |
| Left and right heart catheterization CPT 93452 • Cardiology | $319 | $686 | $1,052 |
| Left heart catheterization CPT 93458 • Cardiology | $393 | $851 | $1,310 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $1,446 | $1,446 | $1,446 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $181 | $200 | $220 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $144 | $144 | $144 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $218 | $218 | $218 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $224 | $224 | $224 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $53 | $53 | $53 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $38 | $52 | $65 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $74 | $74 | $74 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $102 | $102 | $102 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $43 | $60 | $76 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $92 | $92 | $92 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $125 | $125 | $125 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $155 | $155 | $155 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $173 | $173 | $173 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $139 | $139 | $139 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $194 | $194 | $194 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $162 | $201 | $240 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $263 | $263 | $263 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $134 | $170 | $207 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $109 | $109 | $109 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $86 | $86 | $86 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $5 | $7 | $8 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $194 | $194 | $194 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $119 | $119 | $119 |