| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $4 | $5 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $4 | $5 | $6 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $4 | $5 |
| Allergy testing insect venoms CPT 95017 • Allergy | $5 | $6 | $7 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $16 | $22 | $28 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $6 | $8 | $10 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $7 | $10 | $12 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $9 | $12 | $13 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $8 | $18 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $40 | $707 | $1,690 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $40 | $468 | $975 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $40 | $672 | $1,625 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $40 | $243 | $455 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $40 | $429 | $780 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $40 | $720 | $1,495 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $40 | $630 | $1,430 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $40 | $403 | $780 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $40 | $655 | $1,365 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $40 | $293 | $546 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $40 | $195 | $350 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $40 | $1,263 | $2,450 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $40 | $1,003 | $2,450 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $612 | $668 | $725 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $785 | $1,040 | $1,275 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,185 | $2,399 | $2,613 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $275 | $1,971 | $3,072 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,856 | $3,142 | $3,428 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $564 | $654 | $745 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $541 | $640 | $828 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $11 | $16 | $22 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $5 | $8 | $11 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $7 | $9 | $12 |
| Cardiovascular stress test CPT 93015 • Cardiology | $56 | $74 | $94 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $43 | $50 | $57 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $58 | $86 | $114 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $108 | $335 | $562 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $175 | $232 | $302 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $66 | $164 | $271 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $102 | $155 | $190 |
| Stress echocardiography CPT 93350 • Cardiology | $66 | $104 | $149 |
| Left and right heart catheterization CPT 93452 • Cardiology | $891 | $1,038 | $1,185 |
| Left heart catheterization CPT 93458 • Cardiology | $276 | $698 | $978 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $1,225 | $1,371 | $1,517 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $37 | $137 | $202 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $12 | $64 | $109 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $165 | $236 | $325 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $31 | $82 | $168 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $71 | $76 | $82 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $82 | $90 | $97 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $54 | $79 | $101 |