| Allergen specific IgE each allergen CPT 86003 • Allergy | $4 | $5 | $5 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $2 | $4 | $6 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $6 | $12 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $6 | $8 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $17 | $19 | $20 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $6 | $7 | $8 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $9 | $19 | $29 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $10 | $18 | $34 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $9 | $15 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $30 | $70 | $109 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $59 | $403 | $732 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $59 | $300 | $732 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $30 | $55 | $88 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $30 | $79 | $109 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $30 | $89 | $177 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $109 | $364 | $854 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $30 | $232 | $732 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $30 | $89 | $178 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $30 | $74 | $147 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $30 | $96 | $198 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $30 | $68 | $128 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $30 | $250 | $732 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $502 | $771 | $1,039 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $30 | $449 | $868 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $30 | $893 | $1,756 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $6,254 | $6,254 | $6,254 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,377 | $4,667 | $6,957 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $469 | $492 | $514 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $1,172 | $1,571 | $1,971 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $18 | $22 | $29 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $5 | $8 | $11 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $7 | $12 | $16 |
| Cardiovascular stress test CPT 93015 • Cardiology | $68 | $150 | $242 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $33 | $76 | $120 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $59 | $79 | $105 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $177 | $437 | $890 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $57 | $223 | $456 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $59 | $130 | $193 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $128 | $210 | $285 |
| Stress echocardiography CPT 93350 • Cardiology | $396 | $396 | $396 |
| Left and right heart catheterization CPT 93452 • Cardiology | $570 | $622 | $675 |
| Left heart catheterization CPT 93458 • Cardiology | $587 | $2,057 | $3,526 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $312 | $699 | $1,120 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $186 | $257 | $390 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $59 | $79 | $98 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $235 | $323 | $481 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $67 | $314 | $560 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $15 | $39 | $60 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $52 | $67 | $80 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $70 | $176 | $283 |