| Allergen specific IgE each allergen CPT 86003 • Allergy | $2 | $4 | $6 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $3 | $3 | $3 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $5 | $5 |
| Allergy testing insect venoms CPT 95017 • Allergy | $4 | $5 | $7 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $17 | $21 | $24 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $1 | $7 | $11 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $7 | $10 | $12 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $8 | $11 | $14 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $12 | $17 | $25 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $43 | $197 | $500 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $43 | $394 | $752 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $43 | $420 | $732 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $43 | $166 | $408 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $43 | $142 | $333 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $43 | $196 | $496 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $43 | $184 | $460 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $43 | $122 | $347 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $43 | $614 | $1,098 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $43 | $278 | $743 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $43 | $216 | $555 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $43 | $200 | $510 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $43 | $217 | $730 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $508 | $508 | $508 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $893 | $1,189 | $1,431 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $413 | $1,128 | $1,843 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $620 | $2,087 | $3,475 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,420 | $3,149 | $3,878 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $490 | $490 | $490 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $545 | $723 | $823 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $16 | $20 | $23 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $8 | $11 | $14 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $9 | $12 | $15 |
| Cardiovascular stress test CPT 93015 • Cardiology | $59 | $77 | $96 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $26 | $35 | $44 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $71 | $71 | $71 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $63 | $79 | $94 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $56 | $148 | $311 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $169 | $226 | $278 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $158 | $213 | $279 |
| Stress echocardiography CPT 93350 • Cardiology | $93 | $124 | $156 |
| Left and right heart catheterization CPT 93452 • Cardiology | $528 | $528 | $528 |
| Left heart catheterization CPT 93458 • Cardiology | $524 | $700 | $876 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $465 | $710 | $955 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $184 | $213 | $265 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $78 | $94 | $110 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $193 | $262 | $330 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $35 | $145 | $254 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $60 | $68 | $72 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $71 | $79 | $86 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $53 | $89 | $116 |