| Allergen specific IgE each allergen CPT 86003 • Allergy | $2 | $2 | $2 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $3 | $3 | $3 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $4 | $6 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $6 | $8 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $7 | $11 | $16 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $7 | $9 | $11 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $8 | $9 | $12 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $9 | $11 | $14 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $12 | $15 | $19 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $50 | $304 | $500 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $42 | $244 | $521 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $50 | $405 | $602 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $50 | $176 | $241 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $50 | $437 | $658 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $50 | $714 | $1,416 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $50 | $336 | $658 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $42 | $376 | $850 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $50 | $535 | $846 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $42 | $390 | $752 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $50 | $397 | $612 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $50 | $653 | $1,400 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $50 | $795 | $1,200 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $491 | $491 | $491 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $865 | $1,054 | $1,243 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $1,760 | $2,093 | $2,580 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,068 | $2,739 | $3,872 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,307 | $2,418 | $2,530 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $501 | $501 | $501 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $557 | $687 | $817 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $16 | $19 | $22 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $8 | $11 | $14 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $10 | $12 |
| Cardiovascular stress test CPT 93015 • Cardiology | $65 | $80 | $96 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $31 | $37 | $43 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $81 | $81 | $81 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $72 | $175 | $279 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $89 | $122 | $155 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $130 | $176 | $208 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $125 | $217 | $293 |
| Stress echocardiography CPT 93350 • Cardiology | $97 | $136 | $174 |
| Left and right heart catheterization CPT 93452 • Cardiology | $710 | $776 | $842 |
| Left heart catheterization CPT 93458 • Cardiology | $403 | $739 | $1,105 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $315 | $390 | $465 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $183 | $224 | $265 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $12 | $62 | $113 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $197 | $264 | $330 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $179 | $209 | $254 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $11 | $40 | $58 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $68 | $68 | $68 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $36 | $85 | $134 |