| Allergen specific IgE each allergen CPT 86003 • Allergy | $4 | $6 | $7 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $4 | $7 | $11 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $6 | $6 | $7 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $8 | $15 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $11 | $15 | $19 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $8 | $9 | $9 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $9 | $16 | $23 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $30 | $30 | $30 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $13 | $14 | $15 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $42 | $202 | $362 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $33 | $146 | $362 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $42 | $202 | $362 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $42 | $142 | $241 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $42 | $232 | $422 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $42 | $293 | $543 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $42 | $232 | $422 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $33 | $146 | $362 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $42 | $293 | $543 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $42 | $262 | $483 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $42 | $202 | $362 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $42 | $262 | $483 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $42 | $255 | $362 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $819 | $1,041 | $1,264 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,311 | $1,311 | $1,311 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,602 | $2,602 | $2,602 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $1,433 | $3,183 | $5,316 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,961 | $2,961 | $2,961 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $829 | $1,068 | $1,308 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $920 | $1,188 | $1,455 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $16 | $28 | $40 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $8 | $17 | $27 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $10 | $13 |
| Cardiovascular stress test CPT 93015 • Cardiology | $158 | $166 | $175 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $85 | $93 | $101 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $184 | $215 | $245 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $79 | $94 | $123 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $156 | $242 | $329 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $417 | $454 | $491 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $308 | $432 | $596 |
| Stress echocardiography CPT 93350 • Cardiology | $218 | $342 | $467 |
| Left and right heart catheterization CPT 93452 • Cardiology | $1,402 | $1,851 | $2,301 |
| Left heart catheterization CPT 93458 • Cardiology | $1,746 | $2,195 | $2,645 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $1,927 | $2,386 | $2,845 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $208 | $251 | $295 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $92 | $110 | $128 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $235 | $283 | $331 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $171 | $229 | $286 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $37 | $43 | $53 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $67 | $67 | $67 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $157 | $157 | $157 |