| Allergen specific IgE each allergen CPT 86003 • Allergy | $5 | $5 | $5 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $5 | $5 | $5 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $4 | $4 |
| Allergy testing insect venoms CPT 95017 • Allergy | $9 | $10 | $11 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $9 | $15 | $21 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $6 | $8 | $9 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $12 | $14 | $16 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $14 | $17 | $21 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $4 | $12 | $20 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $21 | $21 | $21 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $21 | $21 | $21 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $21 | $21 | $21 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $21 | $21 | $21 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $21 | $21 | $21 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $454 | $533 | $612 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $794 | $930 | $1,065 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $1,735 | $2,003 | $2,272 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,031 | $2,234 | $2,436 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,576 | $2,576 | $2,576 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $376 | $513 | $650 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $450 | $586 | $722 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $22 | $25 | $29 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $5 | $6 | $8 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $9 | $9 | $10 |
| Cardiovascular stress test CPT 93015 • Cardiology | $82 | $99 | $116 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $5 | $25 | $45 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $80 | $127 | $175 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $322 | $322 | $322 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $239 | $244 | $250 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $215 | $218 | $221 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $267 | $279 | $290 |
| Stress echocardiography CPT 93350 • Cardiology | $163 | $186 | $208 |
| Left and right heart catheterization CPT 93452 • Cardiology | $697 | $839 | $981 |
| Left heart catheterization CPT 93458 • Cardiology | $1,128 | $1,191 | $1,254 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $955 | $1,083 | $1,212 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $214 | $238 | $261 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $95 | $109 | $123 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $271 | $290 | $309 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $209 | $211 | $214 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $29 | $54 | $80 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $41 | $66 | $91 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $51 | $79 | $107 |
| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $64 | $100 | $136 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $78 | $124 | $169 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $34 | $71 | $109 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $58 | $94 | $130 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $46 | $79 | $113 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $85 | $105 | $125 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $130 | $136 | $143 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $106 | $151 | $196 |