| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $3 | $4 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $5 | $5 | $6 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $5 | $10 |
| Allergy testing insect venoms CPT 95017 • Allergy | $2 | $6 | $10 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $14 | $17 | $19 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $3 | $4 | $6 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $6 | $16 | $26 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $8 | $19 | $31 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $11 | $25 | $40 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $79 | $319 | $559 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $79 | $377 | $559 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $82 | $306 | $531 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $79 | $226 | $373 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $82 | $436 | $652 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $79 | $538 | $796 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $82 | $351 | $619 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $79 | $377 | $559 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $79 | $552 | $838 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $79 | $494 | $745 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $79 | $377 | $559 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $82 | $413 | $745 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $79 | $377 | $559 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $1,373 | $1,684 | $1,995 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $2,420 | $2,944 | $3,468 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $1,815 | $3,370 | $4,924 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $5,782 | $7,029 | $8,277 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $6,431 | $7,515 | $8,600 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $380 | $882 | $1,384 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $422 | $982 | $1,542 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $9 | $24 | $39 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $4 | $10 | $17 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $5 | $14 | $22 |
| Cardiovascular stress test CPT 93015 • Cardiology | $46 | $118 | $189 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $23 | $58 | $94 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $50 | $121 | $193 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $89 | $292 | $697 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $109 | $348 | $587 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $132 | $159 | $186 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $158 | $202 | $289 |
| Stress echocardiography CPT 93350 • Cardiology | $125 | $218 | $310 |
| Left and right heart catheterization CPT 93452 • Cardiology | $1,771 | $1,771 | $1,771 |
| Left heart catheterization CPT 93458 • Cardiology | $706 | $740 | $773 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $759 | $818 | $877 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $104 | $127 | $150 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $33 | $48 | $64 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $101 | $146 | $190 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $25 | $58 | $90 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $57 | $136 | $191 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $17 | $118 | $220 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $80 | $176 | $272 |