| Allergen specific IgE each allergen CPT 86003 • Allergy | $2 | $5 | $7 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $3 | $5 | $7 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $4 | $5 |
| Allergy testing insect venoms CPT 95017 • Allergy | $4 | $7 | $9 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $23 | $23 | $24 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $8 | $9 | $9 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $10 | $11 | $11 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $12 | $12 | $13 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $15 | $16 | $17 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $30 | $53 | $76 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $30 | $178 | $365 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $30 | $100 | $194 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $30 | $108 | $218 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $30 | $157 | $364 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $30 | $165 | $388 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $30 | $149 | $340 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $30 | $107 | $291 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $30 | $173 | $412 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $30 | $197 | $485 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $30 | $165 | $388 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $30 | $132 | $291 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $30 | $652 | $2,474 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $30 | $424 | $651 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $30 | $739 | $1,146 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $317 | $1,217 | $2,117 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $30 | $1,743 | $2,712 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,775 | $2,775 | $2,775 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $602 | $716 | $831 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $670 | $706 | $742 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $18 | $18 | $19 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $9 | $10 | $10 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $9 | $9 | $9 |
| Cardiovascular stress test CPT 93015 • Cardiology | $74 | $77 | $79 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $36 | $37 | $37 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $98 | $98 | $98 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $80 | $175 | $270 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $81 | $170 | $259 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $82 | $134 | $228 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $30 | $138 | $234 |
| Stress echocardiography CPT 93350 • Cardiology | $30 | $67 | $90 |
| Left and right heart catheterization CPT 93452 • Cardiology | $750 | $750 | $750 |
| Left heart catheterization CPT 93458 • Cardiology | $374 | $783 | $1,195 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $424 | $870 | $1,265 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $50 | $143 | $222 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $14 | $40 | $91 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $270 | $276 | $282 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $43 | $130 | $217 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $69 | $72 | $76 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $30 | $56 | $83 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $37 | $84 | $112 |