| Allergen specific IgE each allergen CPT 86003 • Allergy | $5 | $7 | $9 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $8 | $9 | $11 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $8 | $10 |
| Allergy testing insect venoms CPT 95017 • Allergy | $4 | $11 | $20 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $32 | $40 | $49 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $2 | $8 | $13 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $21 | $21 | $21 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $11 | $18 | $24 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $5 | $19 | $33 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $60 | $211 | $362 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $60 | $261 | $362 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $48 | $54 | $60 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $62 | $152 | $241 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $62 | $446 | $854 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $60 | $567 | $1,098 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $62 | $242 | $422 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $60 | $291 | $450 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $62 | $568 | $1,098 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $62 | $671 | $976 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $60 | $385 | $732 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $62 | $272 | $483 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $62 | $385 | $732 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $1,264 | $1,269 | $1,274 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $2,230 | $2,236 | $2,241 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $3,806 | $4,187 | $4,569 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,573 | $4,420 | $5,369 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $5,989 | $5,989 | $5,989 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $568 | $923 | $1,277 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $1,421 | $1,421 | $1,421 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $29 | $34 | $40 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $14 | $17 | $19 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $15 | $18 | $20 |
| Cardiovascular stress test CPT 93015 • Cardiology | $166 | $170 | $175 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $65 | $71 | $77 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $184 | $194 | $205 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $113 | $250 | $387 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $169 | $278 | $387 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $483 | $487 | $491 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $298 | $402 | $596 |
| Stress echocardiography CPT 93350 • Cardiology | $172 | $319 | $467 |
| Left and right heart catheterization CPT 93452 • Cardiology | $392 | $481 | $571 |
| Left heart catheterization CPT 93458 • Cardiology | $1,916 | $2,200 | $2,484 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $808 | $1,827 | $2,845 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $159 | $310 | $461 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $30 | $90 | $149 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $214 | $353 | $491 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $329 | $389 | $450 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $40 | $57 | $66 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $35 | $105 | $176 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $237 | $237 | $237 |