| Allergen specific IgE each allergen CPT 86003 • Allergy | $2 | $6 | $7 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $3 | $9 | $11 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $5 | $6 |
| Allergy testing insect venoms CPT 95017 • Allergy | $5 | $5 | $5 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $28 | $28 | $28 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $8 | $9 | $11 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $10 | $11 | $12 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $10 | $12 | $14 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $18 | $18 | $19 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $40 | $261 | $371 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $40 | $256 | $371 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $40 | $263 | $371 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $30 | $135 | $247 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $40 | $303 | $433 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $40 | $391 | $556 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $30 | $229 | $433 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $40 | $260 | $371 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $40 | $388 | $556 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $40 | $342 | $494 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $30 | $226 | $371 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $40 | $302 | $494 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $32 | $237 | $371 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $507 | $646 | $714 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $30 | $901 | $1,257 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,244 | $2,403 | $2,562 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $3,011 | $3,011 | $3,011 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $3,358 | $3,358 | $3,358 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $515 | $650 | $729 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $573 | $700 | $811 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $13 | $18 | $23 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $5 | $8 | $11 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $10 | $11 | $12 |
| Cardiovascular stress test CPT 93015 • Cardiology | $63 | $79 | $95 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $33 | $45 | $49 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $117 | $117 | $117 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $221 | $221 | $221 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $156 | $246 | $309 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $73 | $206 | $260 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $131 | $286 | $329 |
| Stress echocardiography CPT 93350 • Cardiology | $253 | $253 | $253 |
| Left and right heart catheterization CPT 93452 • Cardiology | $231 | $857 | $1,157 |
| Left heart catheterization CPT 93458 • Cardiology | $306 | $831 | $1,343 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $348 | $1,202 | $1,445 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $55 | $166 | $249 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $69 | $97 | $108 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $159 | $270 | $315 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $30 | $204 | $257 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $15 | $19 | $22 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $82 | $90 | $99 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $96 | $115 | $133 |