| Allergen specific IgE each allergen CPT 86003 • Allergy | $5 | $6 | $6 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $8 | $9 | $9 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $10 | $11 | $11 |
| Allergy testing insect venoms CPT 95017 • Allergy | $10 | $10 | $10 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $56 | $56 | $56 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $13 | $17 | $22 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $15 | $21 | $27 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $17 | $24 | $32 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $21 | $27 | $32 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $104 | $704 | $1,480 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $101 | $484 | $666 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $101 | $544 | $888 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $104 | $399 | $740 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $104 | $629 | $1,184 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $101 | $797 | $1,332 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $104 | $581 | $888 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $101 | $540 | $888 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $101 | $871 | $1,628 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $104 | $749 | $1,332 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $101 | $548 | $1,036 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $104 | $861 | $1,776 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $101 | $585 | $1,184 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $585 | $1,164 | $1,988 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,023 | $2,264 | $3,504 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,253 | $4,691 | $7,129 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,642 | $5,506 | $8,370 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,930 | $6,120 | $9,311 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $1,721 | $1,721 | $1,721 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $1,051 | $1,485 | $1,918 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $29 | $34 | $40 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $14 | $16 | $17 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $15 | $19 | $23 |
| Cardiovascular stress test CPT 93015 • Cardiology | $129 | $182 | $235 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $117 | $117 | $117 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $153 | $197 | $240 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $867 | $867 | $867 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $396 | $460 | $523 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $154 | $403 | $652 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $211 | $285 | $359 |
| Stress echocardiography CPT 93350 • Cardiology | $124 | $178 | $232 |
| Left and right heart catheterization CPT 93452 • Cardiology | $772 | $772 | $772 |
| Left heart catheterization CPT 93458 • Cardiology | $541 | $1,506 | $2,471 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $1,090 | $1,090 | $1,090 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $69 | $88 | $108 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $21 | $28 | $34 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $68 | $87 | $105 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $60 | $290 | $520 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $90 | $135 | $181 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $104 | $156 | $208 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $39 | $151 | $257 |