| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $5 | $6 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $7 | $11 | $16 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $8 | $14 |
| Allergy testing insect venoms CPT 95017 • Allergy | $12 | $14 | $16 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $30 | $37 | $49 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $10 | $12 | $13 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $13 | $14 | $15 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $16 | $17 | $19 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $19 | $21 | $22 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $75 | $250 | $595 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $75 | $255 | $611 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $75 | $255 | $611 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $75 | $142 | $272 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $75 | $283 | $695 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $75 | $349 | $893 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $75 | $210 | $475 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $75 | $349 | $893 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $60 | $493 | $1,340 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $75 | $233 | $543 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $75 | $187 | $407 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $79 | $1,455 | $3,150 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $79 | $1,775 | $3,150 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $723 | $911 | $1,214 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $210 | $888 | $1,275 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,412 | $2,564 | $2,699 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $507 | $2,878 | $5,099 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $3,373 | $3,663 | $3,869 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $729 | $896 | $1,202 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $755 | $821 | $896 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $17 | $22 | $28 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $8 | $9 | $10 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $11 | $11 | $12 |
| Cardiovascular stress test CPT 93015 • Cardiology | $98 | $125 | $165 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $47 | $51 | $59 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $86 | $103 | $113 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $105 | $279 | $404 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $239 | $373 | $535 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $99 | $182 | $260 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $194 | $330 | $601 |
| Stress echocardiography CPT 93350 • Cardiology | $99 | $172 | $246 |
| Left and right heart catheterization CPT 93452 • Cardiology | $359 | $810 | $1,057 |
| Left heart catheterization CPT 93458 • Cardiology | $448 | $1,320 | $2,369 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $460 | $804 | $1,445 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $225 | $238 | $249 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $102 | $107 | $111 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $303 | $324 | $353 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $227 | $238 | $245 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $94 | $101 | $112 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $77 | $114 | $153 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $55 | $142 | $225 |