| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $4 | $6 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $8 | $8 | $9 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $6 | $8 |
| Allergy testing insect venoms CPT 95017 • Allergy | $7 | $9 | $10 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $13 | $19 | $24 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $1 | $8 | $14 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $18 | $18 | $18 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $19 | $19 | $19 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $18 | $23 | $28 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $62 | $151 | $240 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $50 | $258 | $362 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $42 | $52 | $62 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $50 | $105 | $160 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $42 | $147 | $294 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $50 | $263 | $378 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $50 | $165 | $280 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $42 | $151 | $362 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $42 | $175 | $378 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $42 | $161 | $336 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $104 | $199 | $252 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $42 | $46 | $50 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $42 | $115 | $252 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $715 | $899 | $1,083 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $62 | $983 | $1,905 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $3,883 | $3,883 | $3,883 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,915 | $3,473 | $4,564 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $3,244 | $4,167 | $5,091 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $1,086 | $1,086 | $1,086 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $1,208 | $1,208 | $1,208 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $17 | $25 | $34 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $15 | $16 | $16 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $10 | $14 | $17 |
| Cardiovascular stress test CPT 93015 • Cardiology | $119 | $130 | $141 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $60 | $60 | $60 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $88 | $124 | $159 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $132 | $188 | $301 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $73 | $187 | $301 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $138 | $214 | $290 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $264 | $278 | $284 |
| Stress echocardiography CPT 93350 • Cardiology | $223 | $227 | $230 |
| Left and right heart catheterization CPT 93452 • Cardiology | $826 | $1,070 | $1,313 |
| Left heart catheterization CPT 93458 • Cardiology | $606 | $606 | $606 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $1,359 | $1,731 | $2,103 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $227 | $256 | $284 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $26 | $61 | $96 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $80 | $201 | $287 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $223 | $268 | $312 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $75 | $110 | $145 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $56 | $56 | $56 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $232 | $232 | $232 |