| Allergen specific IgE each allergen CPT 86003 • Allergy | $4 | $4 | $4 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $4 | $4 | $4 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $5 | $8 | $10 |
| Allergy testing insect venoms CPT 95017 • Allergy | $4 | $5 | $5 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $15 | $21 | $28 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $1 | $4 | $7 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $18 | $23 | $28 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $16 | $20 | $23 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $6 | $9 | $12 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $48 | $280 | $512 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $48 | $357 | $512 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $48 | $280 | $512 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $48 | $195 | $341 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $48 | $322 | $597 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $48 | $408 | $767 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $48 | $322 | $597 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $48 | $357 | $512 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $48 | $408 | $767 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $48 | $365 | $682 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $48 | $280 | $512 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $48 | $365 | $682 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $48 | $357 | $512 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $930 | $930 | $930 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,486 | $1,486 | $1,486 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,935 | $2,935 | $2,935 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $3,156 | $3,156 | $3,156 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $3,336 | $3,336 | $3,336 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $928 | $928 | $928 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $1,030 | $1,071 | $1,112 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $26 | $28 | $31 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $19 | $20 | $21 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $10 | $15 | $21 |
| Cardiovascular stress test CPT 93015 • Cardiology | $183 | $188 | $193 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $118 | $118 | $118 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $286 | $286 | $286 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $142 | $557 | $764 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $381 | $381 | $381 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $484 | $504 | $524 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $453 | $519 | $632 |
| Stress echocardiography CPT 93350 • Cardiology | $250 | $372 | $493 |
| Left and right heart catheterization CPT 93452 • Cardiology | $1,626 | $1,626 | $1,626 |
| Left heart catheterization CPT 93458 • Cardiology | $1,230 | $1,628 | $2,025 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $2,235 | $2,235 | $2,235 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $228 | $369 | $510 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $99 | $162 | $226 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $257 | $451 | $644 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $222 | $267 | $313 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $28 | $45 | $58 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $56 | $137 | $217 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $124 | $129 | $133 |