| Allergen specific IgE each allergen CPT 86003 • Allergy | $4 | $4 | $4 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $2 | $3 | $6 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $5 | $6 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $9 | $13 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $24 | $26 | $31 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $1 | $3 | $6 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $9 | $11 | $15 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $11 | $13 | $17 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $5 | $19 | $36 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $33 | $36 | $40 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $34 | $36 | $40 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $33 | $36 | $40 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $33 | $36 | $40 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $33 | $36 | $40 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $33 | $36 | $40 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $33 | $36 | $40 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $33 | $36 | $40 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $33 | $36 | $40 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $33 | $36 | $40 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $33 | $36 | $40 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $33 | $36 | $40 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $33 | $36 | $40 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $573 | $992 | $1,226 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $30 | $1,508 | $2,420 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $30 | $2,125 | $4,221 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $1,631 | $2,972 | $4,956 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,582 | $4,842 | $6,431 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $287 | $539 | $791 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $96 | $566 | $881 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $14 | $19 | $22 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $3 | $8 | $13 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $5 | $9 | $13 |
| Cardiovascular stress test CPT 93015 • Cardiology | $108 | $129 | $169 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $14 | $42 | $59 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $110 | $138 | $172 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $86 | $190 | $398 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $156 | $289 | $376 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $106 | $199 | $296 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $128 | $217 | $357 |
| Stress echocardiography CPT 93350 • Cardiology | $177 | $243 | $320 |
| Left and right heart catheterization CPT 93452 • Cardiology | $355 | $523 | $692 |
| Left heart catheterization CPT 93458 • Cardiology | $442 | $1,013 | $1,774 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $501 | $855 | $1,268 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $59 | $156 | $225 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $124 | $153 | $194 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $38 | $104 | $215 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $80 | $244 | $366 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $30 | $128 | $191 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $22 | $37 | $51 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $9 | $171 | $272 |