| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $4 | $4 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $1 | $4 | $6 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $5 | $8 |
| Allergy testing insect venoms CPT 95017 • Allergy | $7 | $7 | $8 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $7 | $22 | $40 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $7 | $10 | $15 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $1 | $9 | $17 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $2 | $10 | $19 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $14 | $26 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $45 | $47 | $48 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $45 | $47 | $48 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $45 | $47 | $48 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $45 | $47 | $48 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $45 | $47 | $48 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $45 | $47 | $48 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $40 | $45 | $48 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $45 | $47 | $48 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $45 | $47 | $48 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $45 | $47 | $48 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $45 | $47 | $48 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $45 | $47 | $48 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $45 | $47 | $48 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $518 | $728 | $979 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $122 | $923 | $1,724 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,518 | $3,010 | $3,503 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,071 | $3,033 | $4,119 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $3,289 | $3,943 | $4,596 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $51 | $525 | $1,003 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $572 | $757 | $1,116 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $8 | $19 | $31 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $6 | $9 | $15 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $9 | $12 | $16 |
| Cardiovascular stress test CPT 93015 • Cardiology | $42 | $85 | $132 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $42 | $52 | $61 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $79 | $108 | $163 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $148 | $248 | $306 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $121 | $146 | $170 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $81 | $227 | $380 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $27 | $120 | $209 |
| Stress echocardiography CPT 93350 • Cardiology | $208 | $254 | $346 |
| Left and right heart catheterization CPT 93452 • Cardiology | $276 | $864 | $1,584 |
| Left heart catheterization CPT 93458 • Cardiology | $563 | $841 | $1,120 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $637 | $1,032 | $1,252 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $87 | $189 | $292 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $75 | $103 | $157 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $44 | $221 | $392 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $85 | $188 | $291 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $3 | $53 | $103 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $2 | $23 | $44 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $9 | $95 | $181 |