| Allergen specific IgE each allergen CPT 86003 • Allergy | $4 | $5 | $7 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $2 | $4 | $6 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $5 | $8 | $10 |
| Allergy testing insect venoms CPT 95017 • Allergy | $23 | $23 | $23 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $54 | $54 | $54 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $3 | $3 | $3 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $11 | $19 | $26 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $13 | $22 | $31 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $17 | $28 | $40 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $79 | $319 | $559 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $79 | $360 | $559 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $79 | $277 | $559 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $82 | $224 | $373 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $79 | $417 | $652 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $82 | $573 | $838 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $82 | $463 | $655 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $82 | $348 | $559 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $79 | $517 | $838 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $82 | $474 | $745 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $79 | $386 | $559 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $82 | $373 | $745 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $79 | $901 | $2,474 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $651 | $1,340 | $1,995 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,146 | $2,345 | $3,468 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,329 | $4,762 | $7,033 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $5,782 | $7,029 | $8,277 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $6,431 | $7,831 | $9,231 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $1,384 | $1,384 | $1,384 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $742 | $1,142 | $1,542 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $18 | $28 | $39 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $10 | $13 | $17 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $11 | $20 | $28 |
| Cardiovascular stress test CPT 93015 • Cardiology | $74 | $132 | $189 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $94 | $94 | $94 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $193 | $275 | $358 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $697 | $697 | $697 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $81 | $440 | $651 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $215 | $512 | $797 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $139 | $680 | $972 |
| Stress echocardiography CPT 93350 • Cardiology | $90 | $138 | $186 |
| Left and right heart catheterization CPT 93452 • Cardiology | $1,771 | $1,771 | $1,771 |
| Left heart catheterization CPT 93458 • Cardiology | $374 | $1,181 | $1,987 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $424 | $650 | $877 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $50 | $227 | $404 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $16 | $116 | $217 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $101 | $101 | $101 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $43 | $227 | $410 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $43 | $58 | $69 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $86 | $153 | $220 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $42 | $157 | $272 |