| 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 | $3 | $8 | $15 |
| Allergy testing insect venoms CPT 95017 • Allergy | $8 | $12 | $20 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $19 | $28 | $38 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $2 | $7 | $11 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $12 | $17 | $21 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $11 | $17 | $25 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $15 | $22 | $31 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $62 | $308 | $500 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $62 | $267 | $362 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $78 | $327 | $542 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $60 | $195 | $283 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $60 | $367 | $620 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $62 | $674 | $1,416 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $62 | $331 | $510 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $60 | $296 | $400 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $62 | $421 | $659 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $30 | $274 | $714 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $62 | $326 | $555 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $60 | $328 | $483 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $62 | $379 | $730 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $1,057 | $1,160 | $1,264 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,243 | $2,821 | $4,991 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,580 | $3,892 | $4,569 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $485 | $5,014 | $12,121 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,377 | $3,674 | $4,970 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $1,277 | $1,292 | $1,308 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $817 | $1,398 | $1,978 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $22 | $29 | $33 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $14 | $17 | $21 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $12 | $13 | $17 |
| Cardiovascular stress test CPT 93015 • Cardiology | $120 | $179 | $242 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $33 | $66 | $121 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $184 | $236 | $289 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $177 | $297 | $535 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $89 | $343 | $543 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $278 | $497 | $723 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $124 | $541 | $1,053 |
| Stress echocardiography CPT 93350 • Cardiology | $97 | $339 | $467 |
| Left and right heart catheterization CPT 93452 • Cardiology | $500 | $543 | $586 |
| Left heart catheterization CPT 93458 • Cardiology | $394 | $504 | $614 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $447 | $1,609 | $2,845 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $191 | $251 | $298 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $17 | $98 | $166 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $50 | $250 | $461 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $188 | $270 | $364 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $55 | $79 | $126 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $88 | $101 | $113 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $53 | $123 | $193 |