| Allergen specific IgE each allergen CPT 86003 • Allergy | $2 | $3 | $4 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $3 | $3 | $3 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $4 | $5 |
| Allergy testing insect venoms CPT 95017 • Allergy | $10 | $10 | $10 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $8 | $13 | $17 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $1 | $3 | $6 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $9 | $10 | $11 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $11 | $12 | $12 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $4 | $9 | $15 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $50 | $50 | $50 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $50 | $64 | $79 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $50 | $69 | $88 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $50 | $69 | $88 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $50 | $75 | $99 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $50 | $113 | $177 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $50 | $149 | $248 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $50 | $79 | $108 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $50 | $114 | $178 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $50 | $99 | $147 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $50 | $124 | $198 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $50 | $89 | $128 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $50 | $1,134 | $2,219 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $628 | $628 | $628 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,105 | $1,105 | $1,105 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,249 | $2,249 | $2,249 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,643 | $2,643 | $2,643 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,948 | $2,948 | $2,948 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $640 | $640 | $640 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $711 | $711 | $711 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $12 | $16 | $20 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $8 | $9 | $10 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $10 | $10 | $10 |
| Cardiovascular stress test CPT 93015 • Cardiology | $62 | $73 | $83 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $39 | $39 | $39 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $59 | $81 | $103 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $92 | $167 | $243 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $75 | $75 | $75 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $53 | $69 | $86 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $91 | $190 | $289 |
| Stress echocardiography CPT 93350 • Cardiology | $222 | $222 | $222 |
| Left and right heart catheterization CPT 93452 • Cardiology | $791 | $791 | $791 |
| Left heart catheterization CPT 93458 • Cardiology | $1,262 | $1,262 | $1,262 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $971 | $971 | $971 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $136 | $185 | $234 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $15 | $37 | $59 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $46 | $108 | $171 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $41 | $87 | $133 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $60 | $67 | $74 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $70 | $78 | $87 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $82 | $100 | $118 |