| Allergen specific IgE each allergen CPT 86003 • Allergy | $5 | $5 | $5 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $7 | $7 | $7 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $8 | $8 | $8 |
| Allergy testing insect venoms CPT 95017 • Allergy | $10 | $10 | $10 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $25 | $25 | $25 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $10 | $10 | $10 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $11 | $11 | $11 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $13 | $13 | $13 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $16 | $16 | $16 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $684 | $684 | $684 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,187 | $1,187 | $1,187 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,452 | $2,452 | $2,452 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,884 | $2,884 | $2,884 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $3,215 | $3,215 | $3,215 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $707 | $707 | $707 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $784 | $784 | $784 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $21 | $21 | $21 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $10 | $10 | $10 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $11 | $11 | $11 |
| Cardiovascular stress test CPT 93015 • Cardiology | $96 | $96 | $96 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $48 | $48 | $48 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $115 | $115 | $115 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $68 | $183 | $299 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $287 | $287 | $287 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $418 | $418 | $418 |
| Stress echocardiography CPT 93350 • Cardiology | $303 | $303 | $303 |
| Left and right heart catheterization CPT 93452 • Cardiology | $1,099 | $1,099 | $1,099 |
| Left heart catheterization CPT 93458 • Cardiology | $1,344 | $1,344 | $1,344 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $1,485 | $1,485 | $1,485 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $238 | $238 | $238 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $111 | $111 | $111 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $307 | $307 | $307 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $234 | $234 | $234 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $60 | $60 | $60 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $30 | $30 | $30 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $99 | $99 | $99 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $120 | $120 | $120 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $148 | $148 | $148 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $123 | $123 | $123 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $140 | $140 | $140 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $153 | $153 | $153 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $185 | $185 | $185 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $206 | $206 | $206 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $169 | $169 | $169 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $241 | $241 | $241 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $285 | $285 | $285 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $309 | $309 | $309 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $251 | $251 | $251 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $126 | $126 | $126 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $94 | $94 | $94 |