| Allergen specific IgE each allergen CPT 86003 • Allergy | $2 | $4 | $5 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $3 | $4 | $5 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $3 | $4 |
| Allergy testing insect venoms CPT 95017 • Allergy | $4 | $5 | $7 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $16 | $21 | $25 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $6 | $6 | $7 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $7 | $10 | $16 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $8 | $12 | $20 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $4 | $10 | $12 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $50 | $50 | $50 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $50 | $94 | $137 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $50 | $50 | $50 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $50 | $50 | $50 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $50 | $50 | $50 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $50 | $50 | $50 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $50 | $50 | $50 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $50 | $50 | $50 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $50 | $50 | $50 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $50 | $50 | $50 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $50 | $50 | $50 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $50 | $50 | $50 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $50 | $50 | $50 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $410 | $498 | $587 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $721 | $871 | $1,022 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $1,467 | $1,824 | $2,181 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $1,724 | $2,031 | $2,339 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $1,922 | $2,198 | $2,473 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $417 | $520 | $622 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $464 | $531 | $691 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $13 | $17 | $28 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $4 | $5 | $7 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $7 | $8 | $10 |
| Cardiovascular stress test CPT 93015 • Cardiology | $54 | $72 | $111 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $5 | $15 | $26 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $67 | $117 | $167 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $60 | $170 | $224 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $129 | $142 | $155 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $53 | $110 | $159 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $104 | $129 | $154 |
| Stress echocardiography CPT 93350 • Cardiology | $145 | $151 | $156 |
| Left and right heart catheterization CPT 93452 • Cardiology | $516 | $740 | $964 |
| Left heart catheterization CPT 93458 • Cardiology | $232 | $392 | $834 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $285 | $404 | $633 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $122 | $154 | $216 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $62 | $77 | $118 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $164 | $204 | $296 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $39 | $116 | $149 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $28 | $38 | $48 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $39 | $48 | $57 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $44 | $76 | $119 |