| Allergen specific IgE each allergen CPT 86003 • Allergy | $2 | $3 | $4 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $5 | $7 | $8 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $5 | $6 |
| Allergy testing insect venoms CPT 95017 • Allergy | $5 | $7 | $9 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $9 | $29 | $49 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $1 | $4 | $8 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $11 | $11 | $11 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $13 | $19 | $24 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $4 | $8 | $13 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $62 | $62 | $62 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $30 | $45 | $60 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $60 | $60 | $60 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $60 | $60 | $60 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $68 | $68 | $68 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $62 | $62 | $62 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $60 | $60 | $60 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $30 | $46 | $62 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $62 | $62 | $62 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $62 | $62 | $62 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $60 | $60 | $60 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $60 | $60 | $60 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $30 | $46 | $62 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $545 | $611 | $677 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,176 | $1,709 | $2,241 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $1,968 | $2,174 | $2,380 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,135 | $3,432 | $5,369 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $3,110 | $4,550 | $5,989 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $645 | $961 | $1,277 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $616 | $666 | $717 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $22 | $31 | $40 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $7 | $9 | $12 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $10 | $15 | $20 |
| Cardiovascular stress test CPT 93015 • Cardiology | $78 | $92 | $105 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $40 | $49 | $59 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $118 | $161 | $205 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $177 | $282 | $387 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $230 | $308 | $387 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $82 | $129 | $177 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $132 | $315 | $577 |
| Stress echocardiography CPT 93350 • Cardiology | $230 | $336 | $443 |
| Left and right heart catheterization CPT 93452 • Cardiology | $309 | $502 | $695 |
| Left heart catheterization CPT 93458 • Cardiology | $785 | $825 | $865 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $827 | $888 | $948 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $162 | $212 | $262 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $14 | $105 | $196 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $34 | $37 | $41 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $164 | $216 | $268 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $26 | $82 | $149 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $37 | $106 | $176 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $123 | $180 | $237 |