| Allergen specific IgE each allergen CPT 86003 • Allergy | $5 | $6 | $7 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $5 | $8 | $11 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $5 | $7 | $9 |
| Allergy testing insect venoms CPT 95017 • Allergy | $4 | $8 | $12 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $8 | $18 | $28 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $1 | $4 | $6 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $12 | $13 | $13 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $14 | $16 | $17 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $11 | $18 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $50 | $50 | $50 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $50 | $50 | $50 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $50 | $50 | $50 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $50 | $50 | $50 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $50 | $50 | $50 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $50 | $50 | $50 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $50 | $50 | $50 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $50 | $50 | $50 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $50 | $50 | $50 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $50 | $50 | $50 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $50 | $50 | $50 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $50 | $50 | $50 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $50 | $50 | $50 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $579 | $714 | $850 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,051 | $1,264 | $1,476 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,249 | $2,649 | $3,049 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,579 | $3,082 | $3,585 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,827 | $3,412 | $3,998 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $593 | $696 | $799 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $658 | $772 | $887 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $24 | $24 | $24 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $11 | $13 | $16 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $10 | $13 |
| Cardiovascular stress test CPT 93015 • Cardiology | $102 | $105 | $108 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $5 | $30 | $54 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $129 | $137 | $145 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $240 | $240 | $240 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $94 | $155 | $215 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $94 | $183 | $272 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $283 | $377 | $472 |
| Stress echocardiography CPT 93350 • Cardiology | $91 | $164 | $237 |
| Left and right heart catheterization CPT 93452 • Cardiology | $634 | $938 | $1,243 |
| Left heart catheterization CPT 93458 • Cardiology | $1,056 | $1,099 | $1,142 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $522 | $695 | $869 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $30 | $37 | $44 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $102 | $114 | $125 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $59 | $174 | $289 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $213 | $224 | $235 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $27 | $51 | $74 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $37 | $38 | $38 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $51 | $103 | $155 |