| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $4 | $4 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $4 | $5 | $6 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $4 | $6 |
| Allergy testing insect venoms CPT 95017 • Allergy | $8 | $8 | $8 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $19 | $20 | $22 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $1 | $7 | $12 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $8 | $9 | $9 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $11 | $13 | $18 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $14 | $19 | $28 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $30 | $46 | $62 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $30 | $41 | $62 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $30 | $95 | $194 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $30 | $81 | $151 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $30 | $41 | $62 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $30 | $41 | $62 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $30 | $91 | $180 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $30 | $82 | $206 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $30 | $124 | $376 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $30 | $100 | $278 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $30 | $80 | $196 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $30 | $101 | $212 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $30 | $108 | $311 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $30 | $364 | $554 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $30 | $502 | $975 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $30 | $1,005 | $1,981 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $30 | $1,498 | $2,329 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,599 | $2,599 | $2,599 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $567 | $567 | $567 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $631 | $745 | $860 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $13 | $17 | $20 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $5 | $7 | $9 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $10 | $13 |
| Cardiovascular stress test CPT 93015 • Cardiology | $68 | $82 | $115 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $33 | $34 | $35 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $72 | $85 | $92 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $173 | $176 | $177 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $175 | $196 | $217 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $136 | $207 | $292 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $140 | $194 | $235 |
| Stress echocardiography CPT 93350 • Cardiology | $30 | $111 | $183 |
| Left and right heart catheterization CPT 93452 • Cardiology | $895 | $900 | $905 |
| Left heart catheterization CPT 93458 • Cardiology | $318 | $506 | $754 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $360 | $867 | $1,120 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $58 | $151 | $208 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $18 | $62 | $89 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $58 | $198 | $264 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $164 | $255 | $345 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $30 | $44 | $58 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $25 | $73 | $122 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $102 | $102 | $102 |