| Allergen specific IgE each allergen CPT 86003 • Allergy | $7 | $7 | $7 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $5 | $8 | $11 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $9 | $15 |
| Allergy testing insect venoms CPT 95017 • Allergy | $8 | $14 | $18 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $35 | $38 | $42 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $14 | $15 | $16 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $11 | $17 | $24 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $13 | $20 | $26 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $5 | $10 | $17 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $142 | $341 | $540 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $142 | $383 | $606 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $149 | $302 | $540 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $142 | $240 | $360 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $149 | $438 | $630 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $149 | $618 | $909 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $142 | $380 | $707 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $142 | $448 | $606 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $142 | $537 | $810 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $142 | $493 | $720 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $142 | $374 | $540 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $149 | $387 | $720 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $149 | $739 | $1,746 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $651 | $959 | $1,182 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,146 | $1,584 | $2,054 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $57 | $2,467 | $4,242 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $4,651 | $4,954 | $5,223 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,123 | $3,842 | $5,560 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $1,038 | $1,153 | $1,268 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $742 | $950 | $1,152 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $21 | $30 | $37 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $10 | $16 | $24 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $11 | $15 | $18 |
| Cardiovascular stress test CPT 93015 • Cardiology | $74 | $130 | $158 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $71 | $71 | $71 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $67 | $118 | $168 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $49 | $202 | $312 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $81 | $102 | $123 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $215 | $327 | $469 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $139 | $408 | $573 |
| Stress echocardiography CPT 93350 • Cardiology | $90 | $282 | $494 |
| Left and right heart catheterization CPT 93452 • Cardiology | $490 | $660 | $830 |
| Left heart catheterization CPT 93458 • Cardiology | $374 | $819 | $1,372 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $424 | $1,691 | $2,286 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $244 | $353 | $465 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $16 | $73 | $181 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $375 | $446 | $529 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $67 | $179 | $277 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $64 | $87 | $110 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $44 | $48 | $52 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $102 | $166 | $216 |