| Allergen specific IgE each allergen CPT 86003 • Allergy | $2 | $3 | $4 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $1 | $4 | $6 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $4 | $4 |
| Allergy testing insect venoms CPT 95017 • Allergy | $7 | $7 | $8 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $6 | $13 | $18 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $1 | $7 | $13 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $1 | $6 | $9 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $8 | $12 | $17 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $5 | $14 | $22 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $40 | $45 | $55 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $40 | $45 | $55 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $40 | $42 | $47 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $40 | $45 | $55 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $40 | $45 | $55 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $40 | $40 | $40 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $40 | $45 | $55 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $40 | $45 | $55 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $40 | $42 | $47 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $40 | $40 | $40 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $40 | $45 | $55 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $40 | $45 | $55 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $40 | $40 | $40 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $363 | $393 | $423 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $744 | $791 | $839 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $259 | $1,060 | $1,860 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,029 | $2,149 | $2,269 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $339 | $1,384 | $2,428 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $99 | $284 | $469 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $55 | $363 | $549 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $17 | $23 | $27 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $4 | $8 | $13 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $7 | $7 | $8 |
| Cardiovascular stress test CPT 93015 • Cardiology | $15 | $43 | $72 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $21 | $23 | $24 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $43 | $54 | $66 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $64 | $115 | $166 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $109 | $158 | $201 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $56 | $195 | $334 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $84 | $137 | $190 |
| Stress echocardiography CPT 93350 • Cardiology | $61 | $63 | $65 |
| Left and right heart catheterization CPT 93452 • Cardiology | $239 | $364 | $614 |
| Left heart catheterization CPT 93458 • Cardiology | $261 | $283 | $294 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $331 | $747 | $1,164 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $26 | $97 | $148 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $52 | $73 | $94 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $186 | $265 | $411 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $29 | $108 | $154 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $16 | $35 | $63 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $4 | $44 | $84 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $31 | $95 | $159 |