| Allergen specific IgE each allergen CPT 86003 • Allergy | $4 | $4 | $4 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $3 | $3 | $3 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $6 | $10 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $5 | $9 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $9 | $15 | $20 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $8 | $10 | $13 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $15 | $16 | $18 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $17 | $17 | $18 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $9 | $21 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $40 | $522 | $1,480 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $70 | $476 | $666 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $44 | $525 | $888 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $40 | $209 | $518 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $40 | $471 | $1,184 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $44 | $783 | $1,332 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $44 | $1,005 | $2,220 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $44 | $507 | $814 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $70 | $863 | $1,628 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $45 | $734 | $1,332 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $40 | $412 | $1,036 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $40 | $620 | $1,776 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $40 | $1,278 | $4,500 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $644 | $782 | $920 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,084 | $1,084 | $1,084 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,304 | $2,304 | $2,304 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $1,868 | $2,391 | $2,915 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $3,019 | $3,019 | $3,019 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $561 | $561 | $561 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $604 | $795 | $1,051 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $29 | $30 | $31 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $10 | $12 | $14 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $11 | $13 | $15 |
| Cardiovascular stress test CPT 93015 • Cardiology | $124 | $126 | $129 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $40 | $58 | $76 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $153 | $171 | $188 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $78 | $105 | $133 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $256 | $305 | $396 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $154 | $214 | $254 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $211 | $266 | $303 |
| Stress echocardiography CPT 93350 • Cardiology | $124 | $149 | $174 |
| Left and right heart catheterization CPT 93452 • Cardiology | $826 | $847 | $869 |
| Left heart catheterization CPT 93458 • Cardiology | $541 | $739 | $938 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $973 | $989 | $1,004 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $69 | $171 | $243 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $21 | $60 | $98 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $68 | $164 | $260 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $60 | $149 | $237 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $34 | $50 | $66 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $43 | $78 | $113 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $40 | $115 | $157 |