| Allergen specific IgE each allergen CPT 86003 • Allergy | $2 | $3 | $4 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $2 | $3 | $3 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $4 | $6 |
| Allergy testing insect venoms CPT 95017 • Allergy | $2 | $5 | $10 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $17 | $19 | $24 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $6 | $9 | $13 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $7 | $10 | $14 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $8 | $10 | $11 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $10 | $15 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $33 | $36 | $38 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $34 | $134 | $360 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $38 | $60 | $88 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $33 | $101 | $218 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $33 | $150 | $420 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $38 | $197 | $540 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $30 | $75 | $158 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $30 | $129 | $360 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $33 | $198 | $540 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $38 | $185 | $480 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $33 | $135 | $360 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $33 | $71 | $128 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $33 | $143 | $360 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $418 | $495 | $573 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $991 | $1,055 | $1,118 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $1,559 | $1,786 | $2,013 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $38 | $1,373 | $2,330 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,131 | $2,131 | $2,131 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $647 | $647 | $647 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $473 | $473 | $473 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $12 | $16 | $23 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $7 | $8 | $10 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $9 | $10 |
| Cardiovascular stress test CPT 93015 • Cardiology | $57 | $74 | $109 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $33 | $36 | $40 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $59 | $95 | $121 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $62 | $201 | $249 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $169 | $178 | $186 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $69 | $129 | $176 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $91 | $232 | $387 |
| Stress echocardiography CPT 93350 • Cardiology | $100 | $156 | $184 |
| Left and right heart catheterization CPT 93452 • Cardiology | $777 | $777 | $777 |
| Left heart catheterization CPT 93458 • Cardiology | $287 | $471 | $655 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $652 | $960 | $1,268 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $126 | $189 | $306 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $62 | $88 | $130 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $171 | $251 | $389 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $32 | $132 | $231 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $39 | $49 | $58 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $25 | $46 | $70 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $16 | $82 | $160 |