| Allergen specific IgE each allergen CPT 86003 • Allergy | $4 | $4 | $4 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $6 | $6 | $6 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $5 | $5 | $6 |
| Allergy testing insect venoms CPT 95017 • Allergy | $9 | $9 | $9 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $7 | $7 | $7 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $6 | $8 | $11 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $11 | $13 | $15 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $14 | $17 | $20 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $10 | $15 | $19 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $30 | $162 | $496 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $23 | $104 | $272 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $30 | $174 | $542 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $23 | $149 | $451 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $30 | $122 | $333 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $23 | $162 | $510 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $23 | $147 | $442 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $23 | $106 | $278 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $30 | $183 | $578 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $30 | $172 | $533 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $30 | $187 | $595 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $30 | $171 | $531 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $23 | $219 | $730 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $23 | $497 | $758 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,237 | $1,260 | $1,314 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,543 | $2,611 | $2,710 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $3,003 | $3,251 | $3,872 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $3,447 | $3,447 | $3,447 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $794 | $794 | $794 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $588 | $719 | $882 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $15 | $20 | $30 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $14 | $19 | $21 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $11 | $12 |
| Cardiovascular stress test CPT 93015 • Cardiology | $96 | $128 | $140 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $44 | $64 | $83 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $73 | $150 | $199 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $224 | $224 | $224 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $157 | $207 | $311 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $102 | $150 | $197 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $124 | $233 | $391 |
| Stress echocardiography CPT 93350 • Cardiology | $97 | $100 | $103 |
| Left and right heart catheterization CPT 93452 • Cardiology | $850 | $850 | $850 |
| Left heart catheterization CPT 93458 • Cardiology | $295 | $700 | $1,064 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $465 | $883 | $1,165 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $39 | $173 | $265 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $69 | $101 | $143 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $38 | $112 | $330 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $47 | $121 | $330 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $18 | $37 | $61 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $24 | $48 | $76 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $41 | $109 | $154 |