| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $3 | $3 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $5 | $5 | $5 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $4 | $4 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $7 | $9 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $7 | $13 | $19 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $8 | $8 | $8 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $9 | $9 | $9 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $11 | $11 | $11 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $13 | $14 | $15 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $30 | $300 | $570 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $30 | $212 | $570 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $30 | $33 | $35 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $30 | $205 | $380 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $30 | $348 | $665 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $30 | $33 | $35 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $30 | $33 | $35 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $30 | $33 | $35 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $30 | $443 | $855 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $30 | $33 | $35 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $30 | $300 | $570 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $30 | $395 | $760 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $30 | $212 | $570 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $546 | $546 | $546 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $961 | $1,515 | $2,070 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $1,956 | $1,956 | $1,956 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,298 | $2,335 | $2,371 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,563 | $2,563 | $2,563 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $468 | $512 | $556 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $619 | $619 | $619 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $17 | $19 | $20 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $9 | $10 | $12 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $9 | $13 | $17 |
| Cardiovascular stress test CPT 93015 • Cardiology | $72 | $83 | $93 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $34 | $35 | $35 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $90 | $98 | $106 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $80 | $192 | $248 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $143 | $158 | $172 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $211 | $225 | $238 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $217 | $323 | $501 |
| Stress echocardiography CPT 93350 • Cardiology | $193 | $293 | $393 |
| Left and right heart catheterization CPT 93452 • Cardiology | $935 | $1,194 | $1,453 |
| Left heart catheterization CPT 93458 • Cardiology | $789 | $789 | $789 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $990 | $1,092 | $1,195 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $163 | $163 | $163 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $74 | $74 | $74 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $181 | $220 | $259 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $30 | $115 | $199 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $22 | $43 | $64 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $19 | $47 | $76 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $32 | $67 | $102 |