| Allergen specific IgE each allergen CPT 86003 • Allergy | $2 | $3 | $4 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $3 | $3 | $3 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $6 | $8 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $6 | $8 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $20 | $30 | $40 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $8 | $14 | $16 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $9 | $10 | $11 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $10 | $18 | $27 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $15 | $37 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $40 | $40 | $40 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $30 | $35 | $40 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $40 | $40 | $40 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $40 | $40 | $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 | $40 | $40 | $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 | $40 | $40 | $40 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $30 | $35 | $40 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $30 | $589 | $866 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $41 | $376 | $1,047 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $30 | $1,008 | $2,135 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $41 | $1,708 | $2,509 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $41 | $1,740 | $2,798 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $478 | $575 | $718 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $530 | $659 | $860 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $16 | $27 | $32 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $8 | $13 | $15 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $14 | $17 |
| Cardiovascular stress test CPT 93015 • Cardiology | $69 | $111 | $154 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $32 | $65 | $108 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $85 | $129 | $151 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $74 | $96 | $160 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $41 | $49 | $64 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $73 | $303 | $417 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $41 | $90 | $239 |
| Stress echocardiography CPT 93350 • Cardiology | $30 | $161 | $215 |
| Left and right heart catheterization CPT 93452 • Cardiology | $236 | $1,158 | $1,619 |
| Left heart catheterization CPT 93458 • Cardiology | $733 | $1,446 | $2,136 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $785 | $1,066 | $1,180 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $162 | $172 | $191 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $81 | $146 | $179 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $236 | $375 | $512 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $162 | $170 | $186 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $19 | $35 | $41 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $27 | $36 | $41 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $68 | $127 | $202 |