| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $3 | $3 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $2 | $2 | $2 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $5 | $10 | $14 |
| Allergy testing insect venoms CPT 95017 • Allergy | $5 | $5 | $5 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $9 | $29 | $49 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $7 | $7 | $7 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $19 | $19 | $19 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $24 | $24 | $24 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $7 | $9 | $12 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $45 | $53 | $62 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $45 | $388 | $559 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $45 | $302 | $559 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $45 | $53 | $62 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $45 | $227 | $575 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $45 | $541 | $838 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $45 | $348 | $652 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $45 | $388 | $559 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $45 | $541 | $838 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $45 | $483 | $745 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $45 | $200 | $493 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $45 | $53 | $62 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $45 | $200 | $493 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $625 | $920 | $1,214 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,087 | $2,278 | $3,468 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,345 | $4,689 | $7,033 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,511 | $3,805 | $5,099 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,646 | $5,939 | $9,231 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $653 | $653 | $653 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $725 | $1,030 | $1,335 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $32 | $35 | $39 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $19 | $21 | $22 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $10 | $15 | $19 |
| Cardiovascular stress test CPT 93015 • Cardiology | $128 | $147 | $165 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $83 | $83 | $83 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $201 | $201 | $201 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $97 | $131 | $165 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $191 | $290 | $389 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $253 | $374 | $494 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $128 | $396 | $665 |
| Stress echocardiography CPT 93350 • Cardiology | $88 | $305 | $523 |
| Left and right heart catheterization CPT 93452 • Cardiology | $313 | $434 | $554 |
| Left heart catheterization CPT 93458 • Cardiology | $386 | $1,016 | $1,646 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $1,122 | $1,862 | $2,602 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $88 | $177 | $267 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $143 | $168 | $194 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $34 | $295 | $556 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $40 | $184 | $328 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $45 | $109 | $172 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $57 | $92 | $126 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $92 | $109 | $126 |