| Allergen specific IgE each allergen CPT 86003 • Allergy | $7 | $7 | $7 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $11 | $11 | $11 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $12 | $15 |
| Allergy testing insect venoms CPT 95017 • Allergy | $7 | $13 | $18 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $35 | $39 | $42 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $8 | $13 | $16 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $10 | $17 | $21 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $10 | $21 | $27 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $15 | $21 | $27 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $142 | $407 | $540 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $127 | $391 | $606 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $142 | $389 | $606 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $68 | $224 | $360 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $142 | $438 | $630 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $142 | $578 | $909 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $142 | $403 | $630 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $142 | $395 | $606 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $142 | $575 | $909 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $142 | $511 | $808 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $142 | $383 | $540 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $68 | $421 | $720 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $32 | $355 | $540 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $902 | $1,077 | $1,205 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $863 | $1,611 | $2,093 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $44 | $2,760 | $4,323 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $4,651 | $4,902 | $5,223 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $5,192 | $5,563 | $5,831 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $766 | $984 | $1,129 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $605 | $998 | $1,257 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $13 | $30 | $37 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $5 | $17 | $24 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $10 | $16 | $18 |
| Cardiovascular stress test CPT 93015 • Cardiology | $63 | $134 | $158 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $72 | $72 | $72 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $171 | $171 | $171 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $318 | $318 | $318 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $125 | $297 | $486 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $73 | $328 | $469 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $131 | $470 | $625 |
| Stress echocardiography CPT 93350 • Cardiology | $140 | $384 | $494 |
| Left and right heart catheterization CPT 93452 • Cardiology | $1,646 | $1,646 | $1,646 |
| Left heart catheterization CPT 93458 • Cardiology | $306 | $1,119 | $2,061 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $348 | $1,664 | $2,286 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $95 | $234 | $414 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $24 | $113 | $181 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $78 | $346 | $529 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $30 | $271 | $403 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $15 | $79 | $110 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $82 | $113 | $129 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $91 | $132 | $180 |