| Allergen specific IgE each allergen CPT 86003 • Allergy | $6 | $6 | $6 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $7 | $7 | $7 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $4 | $4 |
| Allergy testing insect venoms CPT 95017 • Allergy | $9 | $9 | $9 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $22 | $22 | $22 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $6 | $6 | $6 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $16 | $16 | $16 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $20 | $20 | $20 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $15 | $15 | $15 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $636 | $636 | $636 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,041 | $1,041 | $1,041 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $1,998 | $1,998 | $1,998 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,184 | $2,184 | $2,184 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,376 | $2,376 | $2,376 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $563 | $563 | $563 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $626 | $626 | $626 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $9 | $9 | $9 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $18 | $18 | $18 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $11 | $11 | $11 |
| Cardiovascular stress test CPT 93015 • Cardiology | $116 | $116 | $116 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $68 | $68 | $68 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $38 | $38 | $38 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $176 | $176 | $176 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $155 | $155 | $155 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $195 | $195 | $195 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $132 | $132 | $132 |
| Stress echocardiography CPT 93350 • Cardiology | $78 | $78 | $78 |
| Left and right heart catheterization CPT 93452 • Cardiology | $270 | $270 | $270 |
| Left heart catheterization CPT 93458 • Cardiology | $332 | $332 | $332 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $374 | $374 | $374 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $153 | $153 | $153 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $14 | $14 | $14 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $153 | $153 | $153 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $169 | $169 | $169 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $24 | $24 | $24 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $32 | $32 | $32 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $99 | $102 | $104 |
| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $123 | $127 | $131 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $153 | $156 | $159 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $58 | $58 | $58 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $76 | $76 | $76 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $58 | $58 | $58 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $71 | $71 | $71 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $115 | $115 | $115 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $134 | $134 | $134 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $152 | $152 | $152 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $131 | $131 | $131 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $147 | $147 | $147 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $174 | $174 | $174 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $30 | $109 | $187 |