| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $4 | $4 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $6 | $8 | $11 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $7 | $15 |
| Allergy testing insect venoms CPT 95017 • Allergy | $8 | $12 | $20 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $20 | $22 | $27 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $1 | $4 | $7 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $11 | $11 | $11 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $11 | $13 | $15 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $10 | $16 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $30 | $35 | $40 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $30 | $33 | $40 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $30 | $35 | $40 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $30 | $35 | $40 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $30 | $33 | $40 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $30 | $33 | $40 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $30 | $35 | $40 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $30 | $33 | $40 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $30 | $33 | $40 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $30 | $33 | $40 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $30 | $33 | $40 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $30 | $35 | $40 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $30 | $33 | $40 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $707 | $745 | $819 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,441 | $1,441 | $1,441 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,543 | $2,737 | $2,931 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,823 | $2,932 | $2,986 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $13,514 | $13,514 | $13,514 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $838 | $838 | $838 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $588 | $1,283 | $1,978 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $14 | $27 | $41 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $6 | $9 | $13 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $15 | $21 |
| Cardiovascular stress test CPT 93015 • Cardiology | $71 | $84 | $111 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $35 | $64 | $121 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $72 | $93 | $115 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $261 | $353 | $535 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $211 | $215 | $220 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $117 | $157 | $197 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $175 | $218 | $240 |
| Stress echocardiography CPT 93350 • Cardiology | $93 | $155 | $187 |
| Left and right heart catheterization CPT 93452 • Cardiology | $729 | $814 | $899 |
| Left heart catheterization CPT 93458 • Cardiology | $294 | $589 | $884 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $1,117 | $1,605 | $2,580 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $205 | $205 | $205 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $81 | $88 | $94 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $239 | $324 | $494 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $45 | $45 | $45 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $76 | $101 | $126 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $88 | $90 | $91 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $152 | $152 | $152 |