| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $4 | $5 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $5 | $5 | $5 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $6 | $7 |
| Allergy testing insect venoms CPT 95017 • Allergy | $4 | $10 | $16 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $8 | $10 | $12 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $6 | $10 | $15 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $16 | $24 | $33 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $20 | $30 | $41 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $10 | $22 | $34 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $559 | $559 | $559 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $559 | $559 | $559 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $559 | $559 | $559 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $373 | $373 | $373 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $652 | $652 | $652 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $838 | $838 | $838 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $652 | $652 | $652 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $559 | $559 | $559 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $838 | $838 | $838 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $745 | $745 | $745 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $559 | $559 | $559 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $745 | $745 | $745 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $559 | $559 | $559 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $587 | $1,417 | $1,995 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,022 | $2,460 | $3,468 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,181 | $5,059 | $7,033 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,339 | $5,832 | $8,277 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,473 | $6,429 | $9,231 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $622 | $1,184 | $1,746 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $691 | $1,315 | $1,939 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $14 | $21 | $28 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $14 | $16 | $18 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $10 | $13 | $17 |
| Cardiovascular stress test CPT 93015 • Cardiology | $76 | $93 | $111 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $5 | $41 | $76 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $68 | $118 | $167 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $549 | $549 | $549 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $193 | $211 | $229 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $80 | $148 | $217 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $154 | $367 | $581 |
| Stress echocardiography CPT 93350 • Cardiology | $138 | $147 | $156 |
| Left and right heart catheterization CPT 93452 • Cardiology | $666 | $752 | $838 |
| Left heart catheterization CPT 93458 • Cardiology | $366 | $698 | $1,031 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $412 | $786 | $1,161 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $34 | $61 | $88 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $118 | $129 | $140 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $84 | $190 | $296 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $39 | $233 | $427 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $45 | $98 | $172 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $39 | $144 | $212 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $49 | $188 | $327 |