| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $8 | $13 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $8 | $9 | $10 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $7 | $10 | $12 |
| Allergy testing insect venoms CPT 95017 • Allergy | $6 | $10 | $14 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $57 | $61 | $65 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $3 | $13 | $22 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $15 | $22 | $29 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $32 | $33 | $34 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $9 | $26 | $44 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $64 | $176 | $288 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $50 | $209 | $288 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $77 | $182 | $288 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $64 | $128 | $192 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $45 | $191 | $336 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $77 | $254 | $432 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $50 | $193 | $336 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $35 | $129 | $288 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $77 | $254 | $432 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $64 | $224 | $384 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $64 | $176 | $288 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $77 | $230 | $384 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $35 | $123 | $288 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $681 | $787 | $893 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $2,327 | $2,527 | $2,726 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $4,649 | $5,002 | $5,355 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,866 | $3,312 | $3,758 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $3,370 | $3,775 | $4,180 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $1,400 | $1,489 | $1,578 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $1,448 | $1,594 | $1,739 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $40 | $46 | $52 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $17 | $17 | $18 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $11 | $14 | $17 |
| Cardiovascular stress test CPT 93015 • Cardiology | $204 | $204 | $204 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $94 | $99 | $104 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $204 | $225 | $246 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $223 | $478 | $732 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $157 | $226 | $296 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $271 | $414 | $556 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $335 | $446 | $667 |
| Stress echocardiography CPT 93350 • Cardiology | $218 | $372 | $525 |
| Left and right heart catheterization CPT 93452 • Cardiology | $1,678 | $1,766 | $1,854 |
| Left heart catheterization CPT 93458 • Cardiology | $873 | $1,876 | $2,878 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $2,396 | $2,745 | $3,095 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $116 | $322 | $528 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $108 | $139 | $171 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $114 | $283 | $501 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $33 | $41 | $49 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $28 | $114 | $192 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $61 | $134 | $208 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $128 | $207 | $286 |