| Allergen specific IgE each allergen CPT 86003 • Allergy | $2 | $2 | $2 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $4 | $4 | $4 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $3 | $3 |
| Allergy testing insect venoms CPT 95017 • Allergy | $4 | $4 | $4 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $19 | $19 | $19 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $7 | $7 | $7 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $9 | $9 | $9 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $11 | $11 | $11 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $3 | $3 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $487 | $487 | $487 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $857 | $857 | $857 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $1,764 | $1,764 | $1,764 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,071 | $2,071 | $2,071 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,303 | $2,303 | $2,303 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $496 | $496 | $496 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $552 | $552 | $552 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $14 | $14 | $14 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $6 | $6 | $6 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $8 | $8 |
| Cardiovascular stress test CPT 93015 • Cardiology | $68 | $68 | $68 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $35 | $35 | $35 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $67 | $67 | $67 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $239 | $239 | $239 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $206 | $206 | $206 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $66 | $66 | $66 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $121 | $121 | $121 |
| Stress echocardiography CPT 93350 • Cardiology | $109 | $109 | $109 |
| Left and right heart catheterization CPT 93452 • Cardiology | $222 | $222 | $222 |
| Left heart catheterization CPT 93458 • Cardiology | $277 | $277 | $277 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $313 | $313 | $313 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $177 | $177 | $177 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $11 | $11 | $11 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $187 | $187 | $187 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $142 | $142 | $142 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $15 | $15 | $15 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $77 | $77 | $77 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $94 | $94 | $94 |
| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $118 | $118 | $118 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $54 | $54 | $54 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $33 | $33 | $33 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $114 | $114 | $114 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $36 | $36 | $36 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $43 | $43 | $43 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $81 | $81 | $81 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $101 | $101 | $101 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $163 | $163 | $163 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $102 | $102 | $102 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $117 | $117 | $117 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $142 | $142 | $142 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $154 | $154 | $154 |