| Allergen specific IgE each allergen CPT 86003 • Allergy | $5 | $7 | $8 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $12 | $16 | $20 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $4 | $7 |
| Allergy testing insect venoms CPT 95017 • Allergy | $7 | $10 | $15 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $19 | $25 | $31 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $7 | $11 | $14 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $12 | $14 | $16 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $17 | $18 | $19 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $2 | $12 | $19 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $108 | $297 | $496 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $30 | $177 | $288 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $30 | $217 | $520 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $78 | $232 | $425 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $100 | $299 | $425 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $108 | $597 | $1,416 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $30 | $101 | $165 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $30 | $193 | $347 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $78 | $380 | $578 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $108 | $280 | $384 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $108 | $320 | $595 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $78 | $331 | $531 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $108 | $249 | $311 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $584 | $847 | $1,039 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,243 | $1,363 | $1,484 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $413 | $1,960 | $3,508 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $485 | $2,409 | $4,125 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $4,599 | $4,599 | $4,599 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $1,048 | $1,048 | $1,048 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $817 | $990 | $1,163 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $15 | $23 | $31 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $14 | $19 | $23 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $9 | $13 | $15 |
| Cardiovascular stress test CPT 93015 • Cardiology | $115 | $129 | $142 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $31 | $59 | $104 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $90 | $157 | $223 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $102 | $256 | $386 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $125 | $242 | $359 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $89 | $183 | $337 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $158 | $402 | $513 |
| Stress echocardiography CPT 93350 • Cardiology | $156 | $302 | $449 |
| Left and right heart catheterization CPT 93452 • Cardiology | $475 | $682 | $889 |
| Left heart catheterization CPT 93458 • Cardiology | $431 | $1,049 | $1,914 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $666 | $1,380 | $1,669 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $149 | $246 | $295 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $106 | $152 | $199 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $290 | $398 | $506 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $68 | $147 | $227 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $69 | $72 | $74 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $51 | $86 | $122 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $132 | $153 | $174 |