| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $4 | $6 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $5 | $5 | $6 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $4 | $4 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $5 | $8 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $7 | $11 | $19 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $5 | $6 | $8 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $8 | $10 | $14 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $10 | $13 | $18 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $4 | $8 | $14 |
| Sublingual allergen immunotherapy CPT 95199 • Allergy | $0 | $0 | $0 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $30 | $35 | $40 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $30 | $35 | $40 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $30 | $35 | $40 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $30 | $35 | $40 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $30 | $35 | $40 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $30 | $35 | $40 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $30 | $35 | $40 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $30 | $35 | $40 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $30 | $35 | $40 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $30 | $35 | $40 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $30 | $35 | $40 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $30 | $523 | $1,500 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $30 | $323 | $900 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $357 | $627 | $794 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,181 | $1,349 | $1,472 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,053 | $2,416 | $2,850 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $379 | $2,084 | $3,353 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,648 | $3,420 | $3,868 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $509 | $655 | $857 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $566 | $728 | $954 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $18 | $24 | $28 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $10 | $14 | $18 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $11 | $47 | $116 |
| Cardiovascular stress test CPT 93015 • Cardiology | $83 | $105 | $120 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $44 | $57 | $68 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $82 | $131 | $169 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $88 | $140 | $177 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $69 | $223 | $369 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $68 | $238 | $356 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $271 | $329 | $387 |
| Stress echocardiography CPT 93350 • Cardiology | $62 | $207 | $375 |
| Left and right heart catheterization CPT 93452 • Cardiology | $285 | $682 | $1,281 |
| Left heart catheterization CPT 93458 • Cardiology | $351 | $937 | $1,565 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $395 | $1,040 | $1,735 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $28 | $193 | $314 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $11 | $84 | $137 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $132 | $267 | $402 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $132 | $223 | $306 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $19 | $47 | $71 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $27 | $47 | $87 |