| Allergen specific IgE each allergen CPT 86003 • Allergy | $1 | $2 | $3 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $2 | $3 | $5 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $5 | $8 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $7 | $9 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $20 | $22 | $25 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $1 | $6 | $9 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $1 | $7 | $11 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $6 | $10 | $12 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $11 | $16 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $44 | $48 | $55 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $44 | $48 | $55 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $44 | $48 | $55 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $44 | $48 | $55 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $44 | $48 | $55 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $44 | $48 | $55 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $44 | $48 | $55 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $44 | $48 | $55 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $44 | $48 | $55 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $44 | $48 | $55 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $44 | $48 | $55 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $44 | $48 | $55 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $44 | $48 | $55 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $623 | $665 | $706 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $825 | $1,056 | $1,242 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,198 | $2,364 | $2,530 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,578 | $2,777 | $2,977 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $1,434 | $2,378 | $3,323 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $493 | $580 | $667 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $82 | $412 | $742 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $3 | $12 | $21 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $3 | $7 | $10 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $4 | $7 | $10 |
| Cardiovascular stress test CPT 93015 • Cardiology | $36 | $64 | $93 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $36 | $40 | $48 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $39 | $75 | $111 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $28 | $62 | $95 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $61 | $137 | $288 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $68 | $158 | $206 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $49 | $92 | $134 |
| Stress echocardiography CPT 93350 • Cardiology | $44 | $125 | $206 |
| Left and right heart catheterization CPT 93452 • Cardiology | $969 | $988 | $1,006 |
| Left heart catheterization CPT 93458 • Cardiology | $276 | $594 | $1,230 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $314 | $839 | $1,364 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $49 | $75 | $101 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $43 | $68 | $93 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $48 | $88 | $128 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $32 | $90 | $198 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $13 | $30 | $63 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $2 | $52 | $78 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $53 | $75 | $96 |