| Allergen specific IgE each allergen CPT 86003 • Allergy | $2 | $3 | $4 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $3 | $4 | $5 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $4 | $6 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $7 | $11 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $9 | $16 | $20 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $7 | $9 | $11 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $13 | $13 | $13 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $11 | $13 | $15 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $4 | $4 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $40 | $41 | $42 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $30 | $267 | $732 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $40 | $386 | $732 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $40 | $41 | $42 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $30 | $37 | $42 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $30 | $389 | $1,098 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $30 | $35 | $40 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $40 | $501 | $732 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $30 | $33 | $40 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $30 | $33 | $40 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $30 | $37 | $42 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $40 | $41 | $42 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $30 | $37 | $42 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $507 | $608 | $723 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,272 | $1,272 | $1,272 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $1,818 | $2,207 | $2,595 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,460 | $2,702 | $3,050 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $3,402 | $3,402 | $3,402 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $736 | $736 | $736 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $819 | $819 | $819 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $15 | $19 | $23 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $7 | $9 | $12 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $7 | $9 | $11 |
| Cardiovascular stress test CPT 93015 • Cardiology | $66 | $76 | $92 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $33 | $39 | $46 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $80 | $99 | $117 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $34 | $69 | $104 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $206 | $217 | $228 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $181 | $191 | $201 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $139 | $210 | $268 |
| Stress echocardiography CPT 93350 • Cardiology | $184 | $215 | $250 |
| Left and right heart catheterization CPT 93452 • Cardiology | $219 | $271 | $322 |
| Left heart catheterization CPT 93458 • Cardiology | $404 | $404 | $404 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $1,072 | $1,256 | $1,577 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $51 | $174 | $300 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $80 | $97 | $114 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $50 | $152 | $236 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $44 | $160 | $261 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $21 | $42 | $62 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $21 | $60 | $99 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $134 | $134 | $134 |