| Allergen specific IgE each allergen CPT 86003 • Allergy | $2 | $2 | $2 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $3 | $3 | $3 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $5 | $6 | $6 |
| Allergy testing insect venoms CPT 95017 • Allergy | $4 | $4 | $4 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $26 | $26 | $26 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $10 | $11 | $11 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $8 | $10 | $12 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $9 | $12 | $14 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $4 | $15 | $22 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $62 | $352 | $498 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $60 | $338 | $510 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $60 | $294 | $510 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $60 | $281 | $451 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $60 | $420 | $620 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $60 | $564 | $885 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $60 | $318 | $595 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $62 | $551 | $1,133 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $60 | $508 | $765 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $60 | $424 | $680 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $60 | $382 | $587 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $60 | $389 | $664 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $60 | $450 | $730 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $756 | $756 | $756 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,243 | $1,278 | $1,313 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,580 | $2,617 | $2,653 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $3,111 | $3,492 | $3,872 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $3,046 | $3,046 | $3,046 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $777 | $777 | $777 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $567 | $697 | $803 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $23 | $25 | $27 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $9 | $13 | $15 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $9 | $10 | $12 |
| Cardiovascular stress test CPT 93015 • Cardiology | $120 | $124 | $128 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $43 | $58 | $72 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $99 | $99 | $99 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $88 | $88 | $88 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $67 | $77 | $87 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $102 | $165 | $241 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $158 | $219 | $291 |
| Stress echocardiography CPT 93350 • Cardiology | $75 | $86 | $97 |
| Left and right heart catheterization CPT 93452 • Cardiology | $281 | $684 | $1,088 |
| Left heart catheterization CPT 93458 • Cardiology | $354 | $586 | $879 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $401 | $433 | $465 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $35 | $208 | $323 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $110 | $127 | $143 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $41 | $222 | $330 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $30 | $124 | $282 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $13 | $43 | $75 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $28 | $38 | $49 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $86 | $113 | $132 |