| Allergen specific IgE each allergen CPT 86003 • Allergy | $5 | $6 | $7 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $7 | $7 | $8 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $6 | $7 | $8 |
| Allergy testing insect venoms CPT 95017 • Allergy | $7 | $11 | $17 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $19 | $30 | $42 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $2 | $5 | $8 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $18 | $18 | $18 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $21 | $21 | $21 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $13 | $21 | $28 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $32 | $47 | $62 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $33 | $43 | $62 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $32 | $47 | $62 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $32 | $47 | $62 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $32 | $47 | $62 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $32 | $47 | $62 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $32 | $47 | $62 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $32 | $42 | $62 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $32 | $47 | $62 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $62 | $272 | $483 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $32 | $47 | $62 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $32 | $47 | $62 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $32 | $152 | $362 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $350 | $716 | $1,083 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,905 | $1,905 | $1,905 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $3,883 | $3,883 | $3,883 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $1,433 | $2,477 | $4,564 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $1,598 | $3,344 | $5,091 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $505 | $795 | $1,086 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $1,208 | $1,208 | $1,208 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $16 | $25 | $34 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $8 | $12 | $16 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $13 | $17 |
| Cardiovascular stress test CPT 93015 • Cardiology | $76 | $109 | $141 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $40 | $53 | $65 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $93 | $133 | $174 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $79 | $162 | $329 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $182 | $255 | $329 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $232 | $321 | $411 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $308 | $369 | $490 |
| Stress echocardiography CPT 93350 • Cardiology | $230 | $238 | $245 |
| Left and right heart catheterization CPT 93452 • Cardiology | $236 | $1,017 | $1,799 |
| Left heart catheterization CPT 93458 • Cardiology | $289 | $447 | $606 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $687 | $945 | $1,204 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $173 | $242 | $311 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $92 | $116 | $140 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $235 | $326 | $417 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $32 | $172 | $312 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $38 | $82 | $126 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $49 | $49 | $49 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $202 | $202 | $202 |