| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $3 | $3 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $6 | $6 | $7 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $5 | $7 | $10 |
| Allergy testing insect venoms CPT 95017 • Allergy | $5 | $10 | $15 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $22 | $22 | $23 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $1 | $6 | $11 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $9 | $11 | $12 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $14 | $16 | $19 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $19 | $19 | $20 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $52 | $203 | $496 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $52 | $102 | $248 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $52 | $141 | $312 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $52 | $116 | $238 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $52 | $234 | $592 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $52 | $208 | $510 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $52 | $138 | $300 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $52 | $140 | $400 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $52 | $271 | $700 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $52 | $275 | $714 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $52 | $235 | $595 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $52 | $208 | $510 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $52 | $223 | $730 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $756 | $756 | $756 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,243 | $1,656 | $2,178 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,580 | $3,224 | $4,438 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $485 | $2,171 | $3,111 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $4,099 | $4,965 | $5,831 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $777 | $777 | $777 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $817 | $924 | $1,030 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $18 | $24 | $32 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $7 | $13 | $17 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $10 | $12 | $15 |
| Cardiovascular stress test CPT 93015 • Cardiology | $90 | $110 | $128 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $44 | $58 | $72 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $92 | $119 | $146 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $128 | $263 | $331 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $282 | $297 | $311 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $102 | $177 | $270 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $124 | $214 | $304 |
| Stress echocardiography CPT 93350 • Cardiology | $147 | $210 | $327 |
| Left and right heart catheterization CPT 93452 • Cardiology | $1,003 | $1,003 | $1,003 |
| Left heart catheterization CPT 93458 • Cardiology | $403 | $801 | $1,532 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $465 | $657 | $992 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $60 | $170 | $280 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $20 | $74 | $110 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $226 | $352 | $474 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $48 | $49 | $52 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $13 | $48 | $96 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $86 | $86 | $86 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $134 | $137 | $139 |