| Allergen specific IgE each allergen CPT 86003 • Allergy | $4 | $4 | $5 |
| 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 | $4 | $7 | $8 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $17 | $20 | $25 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $6 | $7 | $7 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $8 | $11 | $16 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $10 | $14 | $20 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $4 | $9 | $13 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $50 | $50 | $50 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $30 | $56 | $89 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $50 | $69 | $88 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $50 | $114 | $178 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $30 | $60 | $99 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $30 | $82 | $167 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $50 | $104 | $158 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $30 | $63 | $108 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $30 | $86 | $178 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $30 | $83 | $168 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $30 | $63 | $108 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $50 | $89 | $128 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $30 | $69 | $128 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $30 | $381 | $587 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $913 | $967 | $1,022 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $30 | $1,354 | $2,181 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $30 | $1,516 | $2,339 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,429 | $2,451 | $2,473 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $540 | $581 | $622 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $485 | $592 | $691 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $11 | $18 | $28 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $5 | $6 | $8 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $9 | $10 |
| Cardiovascular stress test CPT 93015 • Cardiology | $62 | $79 | $111 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $5 | $25 | $37 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $59 | $104 | $167 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $160 | $193 | $243 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $155 | $191 | $227 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $53 | $65 | $80 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $91 | $193 | $293 |
| Stress echocardiography CPT 93350 • Cardiology | $30 | $115 | $159 |
| Left and right heart catheterization CPT 93452 • Cardiology | $590 | $777 | $964 |
| Left heart catheterization CPT 93458 • Cardiology | $251 | $464 | $834 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $285 | $737 | $1,130 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $142 | $184 | $216 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $12 | $64 | $118 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $39 | $229 | $411 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $39 | $122 | $188 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $16 | $49 | $91 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $39 | $55 | $70 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $49 | $71 | $94 |