| Allergen specific IgE each allergen CPT 86003 • Allergy | $2 | $2 | $2 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $3 | $5 | $6 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $5 | $6 |
| Allergy testing insect venoms CPT 95017 • Allergy | $8 | $10 | $13 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $20 | $26 | $33 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $7 | $10 | $12 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $9 | $11 | $14 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $16 | $18 | $21 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $5 | $16 | $28 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $30 | $58 | $86 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $30 | $183 | $480 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $40 | $238 | $480 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $30 | $74 | $151 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $30 | $35 | $40 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $30 | $58 | $86 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $30 | $121 | $248 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $30 | $86 | $196 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $40 | $379 | $720 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $40 | $319 | $640 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $30 | $104 | $196 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $30 | $109 | $212 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $30 | $103 | $311 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $707 | $748 | $789 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $16 | $703 | $1,389 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,831 | $2,831 | $2,831 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,986 | $3,100 | $3,327 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $3,711 | $3,711 | $3,711 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $579 | $714 | $848 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $643 | $815 | $944 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $14 | $21 | $26 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $6 | $9 | $13 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $11 | $14 |
| Cardiovascular stress test CPT 93015 • Cardiology | $71 | $99 | $115 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $51 | $57 | $63 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $90 | $124 | $146 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $257 | $260 | $261 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $257 | $257 | $257 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $288 | $305 | $321 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $36 | $155 | $239 |
| Stress echocardiography CPT 93350 • Cardiology | $114 | $155 | $186 |
| Left and right heart catheterization CPT 93452 • Cardiology | $379 | $379 | $379 |
| Left heart catheterization CPT 93458 • Cardiology | $445 | $1,047 | $1,650 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $1,260 | $1,283 | $1,295 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $58 | $106 | $196 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $18 | $80 | $130 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $58 | $227 | $389 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $192 | $240 | $284 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $17 | $39 | $76 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $88 | $106 | $122 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $41 | $94 | $147 |