| Allergen specific IgE each allergen CPT 86003 • Allergy | $2 | $3 | $4 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $5 | $5 | $5 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $4 | $6 |
| Allergy testing insect venoms CPT 95017 • Allergy | $8 | $8 | $8 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $18 | $19 | $20 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $7 | $9 | $11 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $7 | $9 | $12 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $10 | $11 | $14 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $4 | $14 | $25 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $30 | $196 | $496 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $30 | $216 | $752 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $30 | $212 | $542 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $30 | $177 | $451 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $30 | $134 | $425 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $30 | $382 | $1,416 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $30 | $131 | $312 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $30 | $234 | $814 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $30 | $379 | $1,406 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $30 | $205 | $714 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $30 | $287 | $1,036 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $30 | $210 | $531 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $30 | $1,156 | $4,500 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $30 | $471 | $920 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,243 | $1,460 | $1,677 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $30 | $534 | $1,662 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $30 | $4,257 | $12,121 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $30 | $968 | $1,907 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $404 | $404 | $404 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $588 | $703 | $817 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $16 | $19 | $22 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $12 | $13 | $14 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $11 | $11 | $12 |
| Cardiovascular stress test CPT 93015 • Cardiology | $69 | $78 | $96 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $32 | $35 | $43 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $121 | $137 | $153 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $68 | $122 | $177 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $174 | $285 | $396 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $102 | $134 | $193 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $211 | $295 | $438 |
| Stress echocardiography CPT 93350 • Cardiology | $30 | $79 | $156 |
| Left and right heart catheterization CPT 93452 • Cardiology | $230 | $374 | $519 |
| Left heart catheterization CPT 93458 • Cardiology | $524 | $1,220 | $1,916 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $465 | $844 | $1,120 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $38 | $59 | $71 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $9 | $60 | $110 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $236 | $353 | $494 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $25 | $106 | $259 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $16 | $23 | $30 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $17 | $17 | $17 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $96 | $114 | $132 |