| Allergen specific IgE each allergen CPT 86003 • Allergy | $1 | $1 | $1 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $10 | $10 | $10 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $10 | $10 | $10 |
| Allergy testing insect venoms CPT 95017 • Allergy | $24 | $24 | $24 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $57 | $57 | $57 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $22 | $22 | $22 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $29 | $29 | $29 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $35 | $35 | $35 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $41 | $41 | $41 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $1,389 | $1,389 | $1,389 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $2,446 | $2,446 | $2,446 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $4,986 | $4,986 | $4,986 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $5,854 | $5,854 | $5,854 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $6,504 | $6,504 | $6,504 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $1,400 | $1,400 | $1,400 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $1,558 | $1,558 | $1,558 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $40 | $40 | $40 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $18 | $18 | $18 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $23 | $23 | $23 |
| Cardiovascular stress test CPT 93015 • Cardiology | $204 | $204 | $204 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $106 | $106 | $106 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $204 | $204 | $204 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $732 | $732 | $732 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $451 | $451 | $451 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $556 | $556 | $556 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $667 | $667 | $667 |
| Stress echocardiography CPT 93350 • Cardiology | $525 | $525 | $525 |
| Left and right heart catheterization CPT 93452 • Cardiology | $2,483 | $2,483 | $2,483 |
| Left heart catheterization CPT 93458 • Cardiology | $2,094 | $2,094 | $2,094 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $3,095 | $3,095 | $3,095 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $105 | $105 | $105 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $232 | $232 | $232 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $679 | $679 | $679 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $91 | $91 | $91 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $43 | $43 | $43 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $61 | $61 | $61 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $284 | $284 | $284 |
| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $353 | $353 | $353 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $439 | $439 | $439 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $284 | $284 | $284 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $343 | $343 | $343 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $297 | $297 | $297 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $126 | $126 | $126 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $363 | $363 | $363 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $298 | $298 | $298 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $486 | $486 | $486 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $304 | $304 | $304 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $557 | $557 | $557 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $415 | $415 | $415 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $691 | $691 | $691 |