| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $3 | $3 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $5 | $5 | $5 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $5 | $7 |
| Allergy testing insect venoms CPT 95017 • Allergy | $9 | $9 | $9 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $17 | $20 | $23 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $6 | $7 | $8 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $9 | $10 | $11 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $11 | $12 | $13 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $13 | $14 | $15 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $52 | $222 | $393 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $52 | $232 | $393 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $52 | $178 | $393 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $52 | $177 | $262 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $52 | $206 | $458 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $52 | $273 | $589 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $52 | $213 | $458 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $52 | $231 | $393 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $52 | $273 | $589 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $52 | $241 | $524 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $52 | $214 | $393 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $52 | $234 | $524 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $52 | $764 | $2,219 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $575 | $575 | $575 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $997 | $997 | $997 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,052 | $2,052 | $2,052 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,407 | $2,407 | $2,407 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,680 | $2,680 | $2,680 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $560 | $560 | $560 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $622 | $622 | $622 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $10 | $15 | $21 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $12 | $12 | $12 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $9 | $9 | $9 |
| Cardiovascular stress test CPT 93015 • Cardiology | $62 | $79 | $97 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $57 | $57 | $57 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $59 | $85 | $110 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $86 | $164 | $243 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $221 | $221 | $221 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $69 | $105 | $142 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $91 | $215 | $339 |
| Stress echocardiography CPT 93350 • Cardiology | $78 | $78 | $78 |
| Left and right heart catheterization CPT 93452 • Cardiology | $893 | $893 | $893 |
| Left heart catheterization CPT 93458 • Cardiology | $330 | $330 | $330 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $371 | $371 | $371 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $31 | $83 | $136 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $59 | $82 | $104 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $171 | $253 | $335 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $33 | $34 | $36 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $50 | $54 | $58 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $60 | $65 | $70 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $70 | $85 | $100 |