| Allergen specific IgE each allergen CPT 86003 • Allergy | $2 | $2 | $2 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $3 | $3 | $3 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $5 | $6 |
| Allergy testing insect venoms CPT 95017 • Allergy | $11 | $11 | $11 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $10 | $10 | $10 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $1 | $8 | $12 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $9 | $11 | $13 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $14 | $16 | $18 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $13 | $28 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $40 | $261 | $371 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $40 | $261 | $371 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $40 | $244 | $371 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $40 | $162 | $247 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $40 | $302 | $433 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $40 | $384 | $556 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $40 | $288 | $433 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $40 | $247 | $371 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $40 | $382 | $556 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $40 | $318 | $494 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $40 | $244 | $371 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $40 | $302 | $494 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $40 | $273 | $371 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $507 | $630 | $714 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $30 | $439 | $1,257 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $1,818 | $2,264 | $2,562 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $3,011 | $3,011 | $3,011 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $30 | $1,139 | $3,358 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $729 | $729 | $729 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $573 | $750 | $860 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $14 | $20 | $24 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $6 | $8 | $11 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $11 | $11 | $12 |
| Cardiovascular stress test CPT 93015 • Cardiology | $69 | $94 | $115 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $44 | $44 | $44 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $72 | $93 | $117 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $221 | $221 | $221 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $88 | $88 | $88 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $69 | $199 | $292 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $152 | $237 | $313 |
| Stress echocardiography CPT 93350 • Cardiology | $98 | $176 | $246 |
| Left and right heart catheterization CPT 93452 • Cardiology | $882 | $882 | $882 |
| Left heart catheterization CPT 93458 • Cardiology | $380 | $644 | $1,343 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $1,083 | $1,216 | $1,445 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $38 | $88 | $199 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $79 | $97 | $112 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $58 | $242 | $315 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $44 | $212 | $345 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $21 | $45 | $83 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $30 | $90 | $122 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $133 | $133 | $133 |