| Allergen specific IgE each allergen CPT 86003 • Allergy | $2 | $2 | $2 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $2 | $2 | $2 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $5 | $5 | $5 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $3 | $3 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $24 | $24 | $24 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $8 | $10 | $12 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $9 | $11 | $13 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $10 | $12 | $14 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $11 | $25 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $47 | $341 | $496 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $62 | $444 | $752 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $63 | $382 | $602 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $63 | $198 | $320 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $47 | $409 | $620 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $62 | $431 | $720 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $63 | $312 | $560 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $47 | $321 | $480 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $47 | $448 | $720 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $47 | $414 | $640 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $63 | $379 | $595 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $63 | $411 | $640 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $62 | $438 | $730 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $591 | $624 | $657 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $55 | $960 | $1,583 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $55 | $1,946 | $3,203 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $620 | $1,952 | $2,517 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,387 | $2,596 | $2,804 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $500 | $545 | $590 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $656 | $714 | $803 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $15 | $19 | $23 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $6 | $10 | $14 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $10 | $12 |
| Cardiovascular stress test CPT 93015 • Cardiology | $74 | $121 | $169 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $35 | $61 | $104 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $89 | $89 | $89 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $141 | $141 | $141 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $87 | $229 | $371 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $102 | $185 | $250 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $117 | $167 | $308 |
| Stress echocardiography CPT 93350 • Cardiology | $97 | $115 | $129 |
| Left and right heart catheterization CPT 93452 • Cardiology | $607 | $607 | $607 |
| Left heart catheterization CPT 93458 • Cardiology | $403 | $824 | $1,292 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $465 | $1,255 | $2,111 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $52 | $170 | $265 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $68 | $89 | $113 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $51 | $209 | $330 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $61 | $217 | $438 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $78 | $78 | $78 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $55 | $55 | $55 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $42 | $92 | $134 |