| Allergen specific IgE each allergen CPT 86003 • Allergy | $2 | $2 | $2 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $3 | $5 | $6 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $6 | $10 | $17 |
| Allergy testing insect venoms CPT 95017 • Allergy | $5 | $10 | $14 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $29 | $30 | $31 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $12 | $20 | $27 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $29 | $29 | $29 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $34 | $34 | $34 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $4 | $5 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $123 | $460 | $798 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $60 | $504 | $798 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $61 | $375 | $654 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $61 | $671 | $1,420 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $61 | $587 | $931 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $127 | $1,216 | $2,774 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $47 | $437 | $763 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $60 | $743 | $1,314 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $94 | $1,242 | $2,698 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $61 | $1,138 | $2,556 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $100 | $790 | $1,606 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $123 | $1,189 | $1,739 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $45 | $978 | $1,623 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $746 | $764 | $777 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $913 | $913 | $913 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $3,050 | $3,050 | $3,050 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $3,256 | $3,427 | $3,584 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $3,677 | $3,677 | $3,677 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $3,373 | $3,373 | $3,373 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $588 | $685 | $782 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $19 | $24 | $26 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $8 | $11 | $16 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $11 | $24 | $35 |
| Cardiovascular stress test CPT 93015 • Cardiology | $84 | $90 | $96 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $33 | $40 | $47 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $98 | $121 | $144 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $319 | $394 | $510 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $61 | $76 | $106 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $69 | $148 | $258 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $186 | $313 | $387 |
| Stress echocardiography CPT 93350 • Cardiology | $111 | $167 | $252 |
| Left and right heart catheterization CPT 93452 • Cardiology | $888 | $894 | $899 |
| Left heart catheterization CPT 93458 • Cardiology | $488 | $1,262 | $1,905 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $482 | $834 | $1,498 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $65 | $173 | $305 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $20 | $60 | $109 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $323 | $624 | $925 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $53 | $171 | $309 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $24 | $107 | $190 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $165 | $165 | $165 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $383 | $383 | $383 |