| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $3 | $3 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $6 | $6 | $6 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $6 | $7 | $8 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $3 | $3 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $8 | $8 | $8 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $5 | $7 | $11 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $8 | $11 | $14 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $12 | $15 | $17 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $10 | $19 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $49 | $368 | $558 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $49 | $313 | $558 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $49 | $724 | $1,752 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $62 | $224 | $372 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $49 | $440 | $651 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $62 | $377 | $558 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $62 | $944 | $2,336 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $62 | $328 | $558 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $62 | $426 | $659 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $30 | $848 | $2,556 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $30 | $564 | $1,606 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $49 | $412 | $744 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $62 | $514 | $876 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $756 | $932 | $1,272 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,004 | $1,106 | $1,243 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $413 | $1,605 | $2,361 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $620 | $3,608 | $5,351 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $30 | $1,747 | $3,464 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $506 | $532 | $558 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $552 | $732 | $863 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $19 | $20 | $22 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $11 | $13 | $16 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $12 | $15 |
| Cardiovascular stress test CPT 93015 • Cardiology | $96 | $108 | $130 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $44 | $50 | $57 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $114 | $125 | $136 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $165 | $386 | $496 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $106 | $159 | $212 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $102 | $200 | $259 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $186 | $345 | $438 |
| Stress echocardiography CPT 93350 • Cardiology | $138 | $230 | $345 |
| Left and right heart catheterization CPT 93452 • Cardiology | $426 | $643 | $859 |
| Left heart catheterization CPT 93458 • Cardiology | $460 | $711 | $916 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $465 | $1,256 | $2,105 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $30 | $127 | $280 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $12 | $78 | $113 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $276 | $308 | $330 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $32 | $41 | $56 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $61 | $89 | $144 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $30 | $35 | $41 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $33 | $47 | $56 |