| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $4 | $5 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $5 | $6 | $7 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $3 | $4 |
| Allergy testing insect venoms CPT 95017 • Allergy | $6 | $6 | $6 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $14 | $14 | $14 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $6 | $7 | $9 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $7 | $7 | $7 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $9 | $10 | $12 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $11 | $15 | $20 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $510 | $510 | $510 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $357 | $357 | $357 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $510 | $510 | $510 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $969 | $969 | $969 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $765 | $765 | $765 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $459 | $459 | $459 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $612 | $612 | $612 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $816 | $816 | $816 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $550 | $550 | $550 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $90 | $90 | $90 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $1,324 | $1,324 | $1,324 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $980 | $980 | $980 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $1,088 | $1,088 | $1,088 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $371 | $371 | $371 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $413 | $413 | $413 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $10 | $14 | $17 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $5 | $6 | $7 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $6 | $8 | $11 |
| Cardiovascular stress test CPT 93015 • Cardiology | $52 | $69 | $86 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $27 | $27 | $27 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $52 | $52 | $52 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $186 | $186 | $186 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $158 | $158 | $158 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $84 | $113 | $142 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $95 | $95 | $95 |
| Stress echocardiography CPT 93350 • Cardiology | $85 | $85 | $85 |
| Left and right heart catheterization CPT 93452 • Cardiology | $637 | $637 | $637 |
| Left heart catheterization CPT 93458 • Cardiology | $341 | $437 | $533 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $795 | $795 | $795 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $47 | $94 | $126 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $51 | $51 | $51 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $173 | $173 | $173 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $23 | $100 | $176 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $51 | $51 | $51 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $23 | $23 | $23 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $40 | $89 | $137 |
| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $90 | $131 | $172 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $61 | $61 | $61 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $36 | $36 | $36 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $132 | $132 | $132 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $48 | $48 | $48 |