| Allergen specific IgE each allergen CPT 86003 • Allergy | $4 | $5 | $6 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $5 | $5 | $6 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $6 | $8 | $11 |
| Allergy testing insect venoms CPT 95017 • Allergy | $9 | $14 | $23 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $23 | $38 | $54 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $8 | $15 | $21 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $11 | $14 | $17 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $13 | $22 | $31 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $13 | $26 | $40 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $38 | $59 | $79 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $38 | $45 | $58 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $38 | $59 | $79 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $38 | $59 | $79 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $38 | $48 | $58 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $38 | $59 | $79 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $38 | $48 | $58 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $38 | $52 | $79 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $38 | $60 | $82 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $38 | $59 | $79 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $38 | $59 | $79 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $38 | $48 | $58 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $38 | $45 | $58 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $485 | $700 | $914 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $841 | $1,631 | $2,420 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $3,323 | $3,323 | $3,323 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,004 | $2,636 | $3,901 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $4,304 | $4,324 | $4,345 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $545 | $964 | $1,384 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $1,542 | $1,542 | $1,542 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $21 | $27 | $32 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $11 | $14 | $18 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $9 | $16 | $22 |
| Cardiovascular stress test CPT 93015 • Cardiology | $100 | $125 | $151 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $72 | $80 | $88 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $114 | $141 | $169 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $82 | $287 | $697 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $229 | $292 | $354 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $110 | $182 | $254 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $346 | $380 | $442 |
| Stress echocardiography CPT 93350 • Cardiology | $124 | $177 | $229 |
| Left and right heart catheterization CPT 93452 • Cardiology | $621 | $765 | $910 |
| Left heart catheterization CPT 93458 • Cardiology | $318 | $428 | $538 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $1,251 | $2,111 | $2,970 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $201 | $315 | $430 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $121 | $153 | $184 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $101 | $150 | $199 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $410 | $410 | $410 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $43 | $87 | $134 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $39 | $40 | $41 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $69 | $171 | $272 |