| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $6 | $6 | $6 |
| Allergy testing insect venoms CPT 95017 • Allergy | $15 | $15 | $15 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $37 | $37 | $37 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $13 | $13 | $13 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $9 | $9 | $9 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $17 | $17 | $17 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $5 | $5 | $5 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $1,010 | $1,010 | $1,010 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $23 | $23 | $23 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $10 | $10 | $10 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $8 | $8 |
| Cardiovascular stress test CPT 93015 • Cardiology | $109 | $109 | $109 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $52 | $52 | $52 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $121 | $121 | $121 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $248 | $248 | $248 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $286 | $372 | $457 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $314 | $314 | $314 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $489 | $489 | $489 |
| Stress echocardiography CPT 93350 • Cardiology | $298 | $298 | $298 |
| Left and right heart catheterization CPT 93452 • Cardiology | $2,565 | $2,565 | $2,565 |
| Left heart catheterization CPT 93458 • Cardiology | $1,703 | $1,703 | $1,703 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $3,213 | $3,213 | $3,213 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $306 | $306 | $306 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $130 | $130 | $130 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $389 | $389 | $389 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $300 | $300 | $300 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $120 | $120 | $120 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $138 | $138 | $138 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $160 | $160 | $160 |
| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $201 | $201 | $201 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $245 | $245 | $245 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $159 | $159 | $159 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $193 | $193 | $193 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $168 | $168 | $168 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $183 | $183 | $183 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $199 | $199 | $199 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $243 | $243 | $243 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $268 | $268 | $268 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $223 | $223 | $223 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $312 | $312 | $312 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $360 | $360 | $360 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $384 | $384 | $384 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $320 | $320 | $320 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $181 | $181 | $181 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $102 | $102 | $102 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $30 | $30 | $30 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $256 | $256 | $256 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $175 | $175 | $175 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $205 | $205 | $205 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $203 | $203 | $203 |