| Allergen specific IgE each allergen CPT 86003 • Allergy | $1 | $1 | $1 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $1 | $1 | $1 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $5 | $6 |
| Allergy testing insect venoms CPT 95017 • Allergy | $4 | $4 | $4 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $28 | $28 | $28 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $9 | $10 | $12 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $11 | $12 | $13 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $11 | $15 | $18 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $15 | $20 | $28 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $40 | $205 | $371 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $47 | $263 | $371 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $43 | $203 | $371 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $43 | $134 | $247 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $47 | $304 | $433 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $40 | $384 | $556 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $40 | $213 | $433 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $40 | $247 | $371 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $47 | $384 | $556 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $47 | $320 | $494 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $43 | $245 | $371 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $40 | $249 | $494 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $47 | $275 | $371 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $507 | $630 | $714 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,177 | $1,716 | $2,255 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $30 | $1,470 | $2,562 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $5,457 | $5,457 | $5,457 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $30 | $3,050 | $6,069 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $701 | $701 | $701 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $755 | $809 | $860 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $19 | $21 | $23 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $8 | $11 | $15 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $11 | $12 | $14 |
| Cardiovascular stress test CPT 93015 • Cardiology | $69 | $94 | $115 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $45 | $45 | $45 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $90 | $92 | $95 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $328 | $328 | $328 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $199 | $199 | $199 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $175 | $247 | $307 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $132 | $232 | $313 |
| Stress echocardiography CPT 93350 • Cardiology | $85 | $151 | $184 |
| Left and right heart catheterization CPT 93452 • Cardiology | $1,143 | $1,143 | $1,143 |
| Left heart catheterization CPT 93458 • Cardiology | $445 | $936 | $1,321 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $461 | $1,009 | $1,445 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $58 | $173 | $263 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $17 | $48 | $108 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $50 | $189 | $334 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $50 | $221 | $430 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $30 | $103 | $185 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $58 | $96 | $122 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $263 | $263 | $263 |