| Allergen specific IgE each allergen CPT 86003 • Allergy | $6 | $6 | $6 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $10 | $15 | $21 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $6 | $7 | $10 |
| Allergy testing insect venoms CPT 95017 • Allergy | $5 | $7 | $8 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $11 | $34 | $56 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $2 | $13 | $23 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $15 | $17 | $20 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $17 | $19 | $21 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $12 | $21 | $30 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $87 | $780 | $1,480 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $87 | $539 | $984 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $41 | $333 | $888 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $70 | $417 | $666 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $71 | $719 | $1,184 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $41 | $487 | $1,332 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $41 | $536 | $1,480 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $70 | $679 | $984 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $50 | $872 | $1,406 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $70 | $811 | $1,332 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $70 | $923 | $1,924 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $70 | $959 | $1,776 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $71 | $753 | $1,184 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $811 | $981 | $1,212 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,419 | $1,770 | $2,120 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $1,826 | $2,479 | $3,132 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $4,819 | $5,325 | $5,729 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $30 | $2,053 | $4,076 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $477 | $821 | $1,165 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $1,051 | $1,173 | $1,296 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $27 | $33 | $44 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $14 | $18 | $21 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $15 | $18 | $23 |
| Cardiovascular stress test CPT 93015 • Cardiology | $129 | $165 | $215 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $57 | $65 | $72 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $153 | $184 | $211 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $21 | $346 | $851 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $62 | $189 | $396 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $154 | $333 | $558 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $211 | $420 | $704 |
| Stress echocardiography CPT 93350 • Cardiology | $124 | $291 | $550 |
| Left and right heart catheterization CPT 93452 • Cardiology | $412 | $1,197 | $1,982 |
| Left heart catheterization CPT 93458 • Cardiology | $541 | $1,581 | $2,988 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $2,478 | $2,844 | $3,211 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $28 | $137 | $314 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $21 | $105 | $269 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $68 | $352 | $586 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $57 | $156 | $329 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $25 | $79 | $171 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $50 | $51 | $53 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $84 | $121 | $157 |