| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $3 | $3 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $5 | $5 | $5 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $6 | $6 | $6 |
| Allergy testing insect venoms CPT 95017 • Allergy | $14 | $14 | $14 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $11 | $11 | $11 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $8 | $8 | $8 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $21 | $21 | $21 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $27 | $27 | $27 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $14 | $14 | $14 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $830 | $830 | $830 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,444 | $1,444 | $1,444 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $3,096 | $3,096 | $3,096 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $3,317 | $3,317 | $3,317 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $3,504 | $3,504 | $3,504 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $847 | $847 | $847 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $941 | $941 | $941 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $37 | $37 | $37 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $24 | $24 | $24 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $13 | $13 | $13 |
| Cardiovascular stress test CPT 93015 • Cardiology | $150 | $150 | $150 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $92 | $92 | $92 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $228 | $228 | $228 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $100 | $101 | $102 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $279 | $279 | $279 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $169 | $169 | $169 |
| Stress echocardiography CPT 93350 • Cardiology | $116 | $116 | $116 |
| Left and right heart catheterization CPT 93452 • Cardiology | $1,309 | $1,309 | $1,309 |
| Left heart catheterization CPT 93458 • Cardiology | $1,131 | $1,131 | $1,131 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $1,800 | $1,800 | $1,800 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $46 | $46 | $46 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $141 | $141 | $141 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $45 | $45 | $45 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $330 | $330 | $330 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $63 | $63 | $63 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $56 | $56 | $56 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $168 | $168 | $168 |
| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $211 | $211 | $211 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $106 | $106 | $106 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $93 | $93 | $93 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $79 | $79 | $79 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $62 | $62 | $62 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $68 | $68 | $68 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $176 | $176 | $176 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $144 | $144 | $144 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $167 | $167 | $167 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $149 | $149 | $149 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $245 | $245 | $245 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $282 | $282 | $282 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $205 | $205 | $205 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $249 | $249 | $249 |