| Allergen specific IgE each allergen CPT 86003 • Allergy | $2 | $2 | $2 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $3 | $5 | $7 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $5 | $7 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $4 | $5 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $17 | $20 | $25 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $6 | $8 | $10 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $9 | $10 | $13 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $9 | $12 | $16 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $2 | $6 | $12 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $32 | $41 | $50 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $32 | $51 | $89 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $32 | $63 | $108 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $32 | $57 | $88 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $32 | $64 | $109 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $32 | $86 | $177 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $32 | $110 | $248 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $32 | $58 | $119 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $32 | $87 | $178 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $32 | $83 | $168 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $32 | $63 | $108 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $32 | $70 | $128 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $32 | $102 | $294 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $350 | $548 | $746 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,314 | $1,314 | $1,314 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,696 | $2,696 | $2,696 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $1,433 | $2,011 | $3,165 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $3,517 | $3,517 | $3,517 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $653 | $653 | $653 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $560 | $643 | $727 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $14 | $16 | $18 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $8 | $8 | $8 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $9 | $10 |
| Cardiovascular stress test CPT 93015 • Cardiology | $62 | $77 | $91 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $48 | $48 | $48 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $59 | $81 | $93 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $79 | $182 | $328 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $243 | $261 | $278 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $51 | $123 | $232 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $91 | $219 | $308 |
| Stress echocardiography CPT 93350 • Cardiology | $235 | $240 | $245 |
| Left and right heart catheterization CPT 93452 • Cardiology | $236 | $533 | $830 |
| Left heart catheterization CPT 93458 • Cardiology | $289 | $326 | $363 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $988 | $1,096 | $1,204 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $136 | $165 | $194 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $59 | $80 | $92 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $171 | $237 | $305 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $32 | $70 | $138 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $38 | $67 | $105 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $32 | $49 | $70 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $31 | $83 | $148 |