| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $3 | $3 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $4 | $4 | $4 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $2 | $4 | $5 |
| Allergy testing insect venoms CPT 95017 • Allergy | $2 | $2 | $2 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $5 | $5 | $5 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $3 | $7 | $11 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $8 | $10 | $12 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $11 | $13 | $17 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $5 | $12 | $19 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $41 | $270 | $500 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $41 | $162 | $283 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $41 | $170 | $300 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $41 | $246 | $451 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $41 | $187 | $333 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $41 | $463 | $885 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $41 | $622 | $1,204 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $41 | $587 | $1,133 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $41 | $321 | $602 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $41 | $392 | $743 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $41 | $314 | $587 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $41 | $276 | $510 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $41 | $386 | $730 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $604 | $702 | $816 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,191 | $1,289 | $1,433 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,164 | $2,569 | $2,927 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,541 | $3,161 | $3,872 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,942 | $3,394 | $3,845 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $614 | $746 | $878 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $682 | $820 | $977 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $20 | $25 | $29 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $13 | $13 | $14 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $7 | $11 | $14 |
| Cardiovascular stress test CPT 93015 • Cardiology | $82 | $108 | $123 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $44 | $57 | $66 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $146 | $154 | $162 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $83 | $83 | $83 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $150 | $280 | $378 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $102 | $222 | $364 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $124 | $237 | $397 |
| Stress echocardiography CPT 93350 • Cardiology | $97 | $213 | $385 |
| Left and right heart catheterization CPT 93452 • Cardiology | $918 | $921 | $925 |
| Left heart catheterization CPT 93458 • Cardiology | $524 | $928 | $1,151 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $465 | $1,212 | $1,778 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $156 | $248 | $322 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $84 | $113 | $141 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $65 | $216 | $330 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $28 | $44 | $57 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $33 | $63 | $83 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $36 | $39 | $42 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $37 | $71 | $132 |