| Allergen specific IgE each allergen CPT 86003 • Allergy | $2 | $3 | $4 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $2 | $3 | $4 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $5 | $8 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $7 | $10 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $20 | $23 | $24 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $6 | $9 | $12 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $13 | $13 | $13 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $11 | $11 | $12 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $9 | $15 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $33 | $43 | $52 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $34 | $43 | $57 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $38 | $44 | $50 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $33 | $36 | $38 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $30 | $34 | $40 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $30 | $35 | $45 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $30 | $41 | $52 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $30 | $33 | $38 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $30 | $38 | $52 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $30 | $38 | $50 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $30 | $35 | $42 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $33 | $39 | $45 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $30 | $38 | $50 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $30 | $413 | $635 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,242 | $1,242 | $1,242 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $30 | $751 | $2,194 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $38 | $1,364 | $2,330 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $1,922 | $1,922 | $1,922 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $556 | $556 | $556 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $642 | $642 | $642 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $13 | $17 | $22 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $9 | $11 | $13 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $9 | $9 | $9 |
| Cardiovascular stress test CPT 93015 • Cardiology | $69 | $88 | $109 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $33 | $38 | $49 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $67 | $100 | $132 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $85 | $88 | $93 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $61 | $124 | $186 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $151 | $223 | $296 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $139 | $294 | $387 |
| Stress echocardiography CPT 93350 • Cardiology | $30 | $117 | $232 |
| Left and right heart catheterization CPT 93452 • Cardiology | $264 | $623 | $983 |
| Left heart catheterization CPT 93458 • Cardiology | $1,041 | $1,084 | $1,126 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $263 | $884 | $1,268 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $38 | $131 | $224 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $82 | $112 | $142 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $215 | $236 | $258 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $29 | $29 | $29 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $30 | $43 | $56 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $24 | $42 | $59 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $30 | $30 | $30 |