| Allergen specific IgE each allergen CPT 86003 • Allergy | $2 | $3 | $4 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $3 | $5 | $7 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $4 | $4 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $5 | $8 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $20 | $23 | $25 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $6 | $8 | $9 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $8 | $8 | $9 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $10 | $10 | $10 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $10 | $15 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $48 | $59 | $70 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $30 | $49 | $70 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $48 | $526 | $1,460 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $40 | $503 | $1,420 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $48 | $574 | $1,606 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $37 | $902 | $2,628 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $30 | $1,444 | $4,234 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $30 | $366 | $1,314 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $48 | $938 | $2,698 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $37 | $878 | $2,556 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $48 | $654 | $1,846 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $40 | $597 | $1,704 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $40 | $253 | $876 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $495 | $699 | $833 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $815 | $1,142 | $1,469 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $1,856 | $1,856 | $1,856 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $1,933 | $2,714 | $3,497 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,154 | $2,154 | $2,154 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $505 | $505 | $505 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $519 | $651 | $782 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $11 | $15 | $17 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $4 | $6 | $8 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $7 | $8 | $10 |
| Cardiovascular stress test CPT 93015 • Cardiology | $62 | $71 | $85 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $31 | $31 | $31 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $80 | $87 | $94 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $73 | $175 | $270 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $100 | $129 | $158 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $119 | $162 | $245 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $124 | $211 | $299 |
| Stress echocardiography CPT 93350 • Cardiology | $119 | $174 | $232 |
| Left and right heart catheterization CPT 93452 • Cardiology | $207 | $451 | $695 |
| Left heart catheterization CPT 93458 • Cardiology | $251 | $666 | $1,041 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $522 | $1,007 | $1,422 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $35 | $47 | $65 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $19 | $67 | $100 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $178 | $225 | $301 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $24 | $29 | $33 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $59 | $67 | $76 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $71 | $71 | $71 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $36 | $56 | $95 |