| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $4 | $4 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $4 | $7 | $11 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $5 | $7 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $10 | $20 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $16 | $26 | $36 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $2 | $4 | $6 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $10 | $12 | $14 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $24 | $24 | $24 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $2 | $4 | $5 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $60 | $211 | $362 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $60 | $261 | $362 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $60 | $211 | $362 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $63 | $152 | $241 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $50 | $236 | $422 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $62 | $303 | $543 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $45 | $54 | $63 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $45 | $156 | $362 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $62 | $303 | $543 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $50 | $266 | $483 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $50 | $206 | $362 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $56 | $269 | $483 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $50 | $258 | $362 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $936 | $1,100 | $1,264 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $2,230 | $2,236 | $2,241 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $3,349 | $3,349 | $3,349 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $45 | $3,001 | $5,316 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $4,062 | $4,062 | $4,062 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $446 | $680 | $914 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $1,421 | $1,421 | $1,421 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $40 | $40 | $40 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $13 | $13 | $13 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $20 | $20 | $20 |
| Cardiovascular stress test CPT 93015 • Cardiology | $166 | $170 | $175 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $53 | $53 | $53 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $184 | $194 | $205 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $58 | $92 | $125 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $154 | $276 | $397 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $226 | $359 | $491 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $45 | $352 | $596 |
| Stress echocardiography CPT 93350 • Cardiology | $172 | $319 | $467 |
| Left and right heart catheterization CPT 93452 • Cardiology | $198 | $872 | $1,545 |
| Left heart catheterization CPT 93458 • Cardiology | $2,484 | $2,484 | $2,484 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $1,397 | $2,121 | $2,845 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $155 | $202 | $250 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $196 | $196 | $196 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $336 | $336 | $336 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $57 | $57 | $57 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $40 | $42 | $45 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $45 | $110 | $176 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $237 | $237 | $237 |