| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $3 | $3 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $5 | $5 | $5 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $5 | $8 | $10 |
| Allergy testing insect venoms CPT 95017 • Allergy | $13 | $13 | $13 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $11 | $11 | $11 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $8 | $9 | $11 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $12 | $16 | $20 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $17 | $19 | $21 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $13 | $16 | $19 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $60 | $478 | $873 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $50 | $581 | $1,140 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $60 | $308 | $564 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $60 | $308 | $582 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $60 | $575 | $1,019 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $27 | $355 | $846 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $50 | $355 | $714 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $27 | $394 | $1,140 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $60 | $637 | $981 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $50 | $557 | $872 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $50 | $525 | $873 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $50 | $1,132 | $2,836 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $50 | $1,076 | $2,324 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $701 | $794 | $887 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,040 | $1,168 | $1,243 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,580 | $2,688 | $2,887 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,712 | $3,142 | $3,872 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,945 | $2,979 | $3,013 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $577 | $690 | $804 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $642 | $784 | $893 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $22 | $33 | $42 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $12 | $17 | $24 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $13 | $14 | $15 |
| Cardiovascular stress test CPT 93015 • Cardiology | $120 | $143 | $165 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $43 | $78 | $103 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $199 | $199 | $199 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $133 | $133 | $133 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $115 | $220 | $311 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $102 | $221 | $291 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $158 | $267 | $415 |
| Stress echocardiography CPT 93350 • Cardiology | $156 | $197 | $231 |
| Left and right heart catheterization CPT 93452 • Cardiology | $1,037 | $1,037 | $1,037 |
| Left heart catheterization CPT 93458 • Cardiology | $403 | $801 | $1,573 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $465 | $1,164 | $1,607 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $44 | $201 | $293 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $110 | $148 | $200 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $330 | $340 | $346 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $37 | $173 | $422 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $23 | $53 | $73 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $89 | $89 | $89 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $53 | $110 | $168 |