| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $4 | $6 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $4 | $6 | $7 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $6 | $7 |
| Allergy testing insect venoms CPT 95017 • Allergy | $9 | $10 | $10 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $24 | $25 | $27 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $1 | $5 | $8 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $12 | $15 | $17 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $15 | $18 | $21 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $13 | $15 | $17 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $611 | $611 | $611 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $407 | $407 | $407 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $611 | $611 | $611 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $272 | $272 | $272 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $713 | $713 | $713 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $917 | $917 | $917 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $475 | $475 | $475 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $611 | $611 | $611 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $611 | $611 | $611 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $815 | $815 | $815 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $611 | $611 | $611 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $857 | $857 | $857 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $1,682 | $1,682 | $1,682 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $899 | $979 | $1,060 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,055 | $1,482 | $1,909 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $346 | $2,020 | $3,693 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,542 | $3,650 | $4,758 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,824 | $3,804 | $4,783 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $607 | $741 | $875 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $676 | $916 | $1,156 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $8 | $13 | $17 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $7 | $13 | $18 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $9 | $14 | $19 |
| Cardiovascular stress test CPT 93015 • Cardiology | $85 | $103 | $121 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $44 | $61 | $77 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $85 | $89 | $92 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $305 | $365 | $425 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $259 | $283 | $308 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $79 | $110 | $140 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $181 | $229 | $277 |
| Stress echocardiography CPT 93350 • Cardiology | $139 | $186 | $233 |
| Left and right heart catheterization CPT 93452 • Cardiology | $439 | $605 | $771 |
| Left heart catheterization CPT 93458 • Cardiology | $338 | $471 | $604 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $690 | $804 | $918 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $224 | $233 | $242 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $23 | $60 | $97 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $232 | $236 | $240 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $220 | $237 | $254 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $55 | $90 | $126 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $66 | $82 | $97 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $114 | $146 | $178 |