| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $3 | $4 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $5 | $5 | $5 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $4 | $7 |
| Allergy testing insect venoms CPT 95017 • Allergy | $2 | $6 | $8 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $13 | $17 | $20 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $6 | $8 | $11 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $8 | $9 | $12 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $9 | $12 | $17 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $12 | $17 | $25 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $42 | $198 | $500 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $30 | $99 | $283 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $30 | $189 | $486 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $42 | $111 | $238 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $30 | $137 | $425 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $30 | $382 | $1,416 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $30 | $169 | $425 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $30 | $100 | $278 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $30 | $203 | $700 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $30 | $170 | $555 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $30 | $170 | $555 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $42 | $205 | $521 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $30 | $214 | $730 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $30 | $382 | $594 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $913 | $1,078 | $1,243 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $30 | $1,165 | $2,580 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $30 | $2,183 | $3,872 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $42 | $1,334 | $2,626 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $449 | $449 | $449 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $539 | $678 | $817 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $13 | $17 | $22 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $6 | $9 | $14 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $7 | $8 | $12 |
| Cardiovascular stress test CPT 93015 • Cardiology | $66 | $78 | $96 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $33 | $41 | $45 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $79 | $80 | $80 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $69 | $188 | $317 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $64 | $120 | $210 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $102 | $174 | $220 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $112 | $193 | $268 |
| Stress echocardiography CPT 93350 • Cardiology | $30 | $103 | $212 |
| Left and right heart catheterization CPT 93452 • Cardiology | $264 | $469 | $675 |
| Left heart catheterization CPT 93458 • Cardiology | $329 | $591 | $1,041 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $465 | $881 | $1,120 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $31 | $161 | $265 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $61 | $84 | $110 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $169 | $227 | $330 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $26 | $140 | $254 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $30 | $36 | $42 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $11 | $27 | $42 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $36 | $75 | $132 |