| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $5 | $6 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $5 | $5 | $5 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $6 | $10 | $15 |
| Allergy testing insect venoms CPT 95017 • Allergy | $5 | $11 | $18 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $29 | $35 | $42 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $1 | $9 | $16 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $13 | $18 | $24 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $16 | $22 | $26 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $17 | $24 | $30 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $56 | $298 | $540 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $56 | $401 | $606 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $56 | $331 | $606 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $56 | $208 | $360 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $56 | $432 | $630 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $56 | $583 | $909 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $56 | $382 | $707 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $56 | $401 | $606 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $56 | $583 | $909 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $56 | $520 | $808 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $56 | $373 | $540 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $56 | $388 | $720 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $56 | $373 | $540 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $763 | $922 | $1,101 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $44 | $680 | $1,316 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $44 | $2,017 | $3,238 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $3,249 | $4,374 | $5,223 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $3,619 | $4,725 | $5,831 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $717 | $742 | $766 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $796 | $1,104 | $1,411 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $25 | $31 | $37 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $14 | $19 | $24 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $11 | $15 | $18 |
| Cardiovascular stress test CPT 93015 • Cardiology | $118 | $140 | $158 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $69 | $69 | $69 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $133 | $133 | $133 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $108 | $108 | $108 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $193 | $272 | $350 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $200 | $334 | $469 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $422 | $501 | $573 |
| Stress echocardiography CPT 93350 • Cardiology | $96 | $332 | $494 |
| Left and right heart catheterization CPT 93452 • Cardiology | $338 | $338 | $338 |
| Left heart catheterization CPT 93458 • Cardiology | $1,468 | $1,580 | $1,692 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $1,153 | $1,770 | $2,286 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $329 | $334 | $339 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $140 | $160 | $181 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $427 | $463 | $529 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $53 | $179 | $306 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $45 | $75 | $110 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $33 | $49 | $64 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $137 | $159 | $180 |