| Allergen specific IgE each allergen CPT 86003 • Allergy | $1 | $3 | $5 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $10 | $11 | $11 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $10 | $11 | $12 |
| Allergy testing insect venoms CPT 95017 • Allergy | $10 | $10 | $10 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $10 | $34 | $57 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $10 | $16 | $22 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $12 | $16 | $19 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $13 | $24 | $35 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $4 | $23 | $41 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $64 | $64 | $64 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $56 | $56 | $56 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $35 | $50 | $64 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $35 | $46 | $56 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $77 | $77 | $77 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $64 | $64 | $64 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $35 | $46 | $56 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $35 | $45 | $64 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $35 | $50 | $64 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $35 | $39 | $42 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $35 | $56 | $77 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $35 | $50 | $64 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $35 | $49 | $77 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $1,389 | $1,511 | $1,632 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,198 | $1,822 | $2,446 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,623 | $3,805 | $4,986 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,675 | $4,264 | $5,854 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $3,196 | $4,850 | $6,504 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $1,400 | $1,482 | $1,563 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $1,558 | $1,649 | $1,739 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $40 | $45 | $49 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $18 | $21 | $24 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $17 | $21 | $25 |
| Cardiovascular stress test CPT 93015 • Cardiology | $204 | $204 | $204 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $83 | $94 | $106 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $204 | $236 | $269 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $238 | $485 | $732 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $171 | $340 | $509 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $224 | $390 | $556 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $335 | $584 | $751 |
| Stress echocardiography CPT 93350 • Cardiology | $150 | $338 | $525 |
| Left and right heart catheterization CPT 93452 • Cardiology | $1,952 | $2,218 | $2,483 |
| Left heart catheterization CPT 93458 • Cardiology | $918 | $1,898 | $2,878 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $1,390 | $2,242 | $3,095 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $102 | $355 | $608 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $179 | $219 | $259 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $41 | $360 | $679 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $237 | $378 | $519 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $35 | $104 | $202 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $61 | $75 | $88 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $57 | $171 | $284 |