| Allergen specific IgE each allergen CPT 86003 • Allergy | $4 | $7 | $11 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $6 | $11 | $17 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $6 | $8 | $10 |
| Allergy testing insect venoms CPT 95017 • Allergy | $11 | $11 | $11 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $27 | $27 | $27 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $8 | $8 | $8 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $14 | $14 | $14 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $17 | $17 | $17 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $3 | $3 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $100 | $100 | $100 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $100 | $100 | $100 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $100 | $100 | $100 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $100 | $100 | $100 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $100 | $100 | $100 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $100 | $100 | $100 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $100 | $100 | $100 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $100 | $100 | $100 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $100 | $100 | $100 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $100 | $100 | $100 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $100 | $100 | $100 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $100 | $100 | $100 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $100 | $100 | $100 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $783 | $801 | $820 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $42 | $699 | $1,357 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,797 | $2,929 | $3,060 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $3,229 | $3,253 | $3,278 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $3,462 | $3,510 | $3,558 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $908 | $908 | $908 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $1,008 | $1,008 | $1,008 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $28 | $31 | $34 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $21 | $21 | $21 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $13 | $13 | $13 |
| Cardiovascular stress test CPT 93015 • Cardiology | $126 | $140 | $155 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $95 | $95 | $95 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $204 | $204 | $204 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $256 | $256 | $256 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $328 | $328 | $328 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $300 | $335 | $371 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $469 | $469 | $469 |
| Stress echocardiography CPT 93350 • Cardiology | $118 | $118 | $118 |
| Left and right heart catheterization CPT 93452 • Cardiology | $972 | $972 | $972 |
| Left heart catheterization CPT 93458 • Cardiology | $1,216 | $1,216 | $1,216 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $602 | $602 | $602 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $45 | $154 | $262 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $182 | $182 | $182 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $462 | $462 | $462 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $377 | $377 | $377 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $42 | $53 | $63 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $73 | $75 | $78 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $66 | $82 | $99 |