| 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 | $3 | $3 | $3 |
| Allergy testing insect venoms CPT 95017 • Allergy | $8 | $8 | $8 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $18 | $18 | $18 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $7 | $7 | $7 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $17 | $17 | $17 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $19 | $19 | $19 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $16 | $16 | $16 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $902 | $902 | $902 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,726 | $1,726 | $1,726 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $3,565 | $3,565 | $3,565 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $3,797 | $3,797 | $3,797 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $4,674 | $4,674 | $4,674 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $1,027 | $1,027 | $1,027 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $895 | $895 | $895 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $6 | $6 | $6 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $6 | $6 | $6 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $8 | $8 |
| Cardiovascular stress test CPT 93015 • Cardiology | $36 | $36 | $36 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $36 | $36 | $36 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $32 | $32 | $32 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $261 | $261 | $261 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $121 | $121 | $121 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $122 | $122 | $122 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $407 | $407 | $407 |
| Stress echocardiography CPT 93350 • Cardiology | $66 | $66 | $66 |
| Left and right heart catheterization CPT 93452 • Cardiology | $485 | $485 | $485 |
| Left heart catheterization CPT 93458 • Cardiology | $596 | $596 | $596 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $527 | $527 | $527 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $227 | $227 | $227 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $66 | $66 | $66 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $59 | $59 | $59 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $52 | $52 | $52 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $125 | $125 | $125 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $107 | $107 | $107 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $67 | $67 | $67 |
| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $83 | $83 | $83 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $115 | $115 | $115 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $52 | $52 | $52 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $91 | $91 | $91 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $179 | $179 | $179 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $89 | $89 | $89 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $147 | $147 | $147 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $212 | $212 | $212 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $204 | $204 | $204 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $193 | $193 | $193 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $215 | $215 | $215 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $261 | $261 | $261 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $304 | $304 | $304 |