| Allergen specific IgE each allergen CPT 86003 • Allergy | $5 | $9 | $13 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $11 | $16 | $20 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $7 | $10 | $13 |
| Allergy testing insect venoms CPT 95017 • Allergy | $9 | $12 | $14 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $20 | $38 | $56 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $3 | $13 | $23 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $27 | $28 | $29 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $31 | $32 | $34 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $9 | $25 | $41 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $43 | $166 | $288 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $51 | $143 | $288 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $56 | $172 | $288 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $77 | $134 | $192 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $64 | $200 | $336 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $64 | $248 | $432 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $77 | $206 | $336 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $51 | $138 | $288 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $64 | $248 | $432 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $64 | $224 | $384 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $89 | $189 | $288 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $77 | $230 | $384 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $30 | $136 | $288 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $1,319 | $1,475 | $1,632 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,145 | $1,736 | $2,327 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $4,649 | $5,099 | $5,549 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,712 | $4,819 | $6,293 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $6,057 | $6,538 | $7,019 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $1,300 | $1,411 | $1,523 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $1,448 | $1,594 | $1,739 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $39 | $43 | $47 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $18 | $22 | $26 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $21 | $23 | $24 |
| Cardiovascular stress test CPT 93015 • Cardiology | $193 | $199 | $204 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $97 | $101 | $104 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $206 | $226 | $246 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $238 | $424 | $762 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $157 | $424 | $692 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $550 | $575 | $600 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $234 | $534 | $713 |
| Stress echocardiography CPT 93350 • Cardiology | $330 | $425 | $519 |
| Left and right heart catheterization CPT 93452 • Cardiology | $295 | $1,421 | $2,547 |
| Left heart catheterization CPT 93458 • Cardiology | $368 | $547 | $726 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $3,146 | $3,185 | $3,224 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $102 | $112 | $122 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $37 | $138 | $240 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $114 | $414 | $715 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $106 | $283 | $460 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $20 | $60 | $121 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $55 | $141 | $226 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $98 | $110 | $122 |