| Allergen specific IgE each allergen CPT 86003 • Allergy | $2 | $2 | $2 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $3 | $3 | $3 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $6 | $8 |
| Allergy testing insect venoms CPT 95017 • Allergy | $4 | $5 | $7 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $20 | $29 | $38 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $8 | $12 | $16 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $10 | $15 | $20 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $12 | $18 | $23 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $16 | $29 |
| 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 | $1,034 | $1,139 | $1,244 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,822 | $2,006 | $2,190 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $3,743 | $4,118 | $4,493 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,952 | $4,207 | $5,276 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $4,881 | $5,371 | $5,861 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $514 | $779 | $1,043 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $572 | $869 | $1,165 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $14 | $21 | $28 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $6 | $10 | $13 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $11 | $15 |
| Cardiovascular stress test CPT 93015 • Cardiology | $72 | $102 | $132 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $38 | $54 | $71 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $72 | $106 | $139 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $258 | $364 | $510 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $60 | $84 | $108 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $129 | $251 | $373 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $235 | $334 | $445 |
| Stress echocardiography CPT 93350 • Cardiology | $118 | $234 | $351 |
| Left and right heart catheterization CPT 93452 • Cardiology | $454 | $669 | $883 |
| Left heart catheterization CPT 93458 • Cardiology | $1,024 | $1,531 | $2,037 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $324 | $1,258 | $2,192 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $37 | $38 | $38 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $31 | $91 | $161 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $203 | $335 | $466 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $82 | $212 | $367 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $139 | $157 | $175 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $53 | $106 | $158 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $71 | $159 | $246 |