| Allergen specific IgE each allergen CPT 86003 • Allergy | $4 | $6 | $7 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $7 | $9 | $11 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $5 | $5 | $5 |
| Allergy testing insect venoms CPT 95017 • Allergy | $11 | $11 | $11 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $28 | $28 | $28 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $7 | $7 | $7 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $19 | $19 | $19 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $24 | $24 | $24 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $3 | $3 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $48 | $205 | $362 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $48 | $257 | $362 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $48 | $205 | $362 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $48 | $145 | $241 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $48 | $235 | $422 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $48 | $296 | $543 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $48 | $235 | $422 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $48 | $257 | $362 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $48 | $296 | $543 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $48 | $265 | $483 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $48 | $205 | $362 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $48 | $265 | $483 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $48 | $257 | $362 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $874 | $1,069 | $1,264 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,521 | $1,876 | $2,230 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $3,257 | $3,893 | $4,528 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $3,490 | $4,403 | $5,316 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $3,673 | $4,797 | $5,920 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $675 | $991 | $1,308 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $749 | $1,102 | $1,455 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $32 | $32 | $32 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $22 | $22 | $22 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $10 | $10 | $10 |
| Cardiovascular stress test CPT 93015 • Cardiology | $138 | $156 | $175 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $85 | $88 | $92 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $184 | $201 | $219 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $106 | $106 | $106 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $79 | $117 | $156 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $88 | $290 | $491 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $133 | $365 | $596 |
| Stress echocardiography CPT 93350 • Cardiology | $97 | $282 | $467 |
| Left and right heart catheterization CPT 93452 • Cardiology | $586 | $907 | $1,229 |
| Left heart catheterization CPT 93458 • Cardiology | $399 | $1,158 | $1,916 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $1,689 | $2,267 | $2,845 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $270 | $270 | $270 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $144 | $144 | $144 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $362 | $362 | $362 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $255 | $255 | $255 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $37 | $45 | $58 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $49 | $49 | $49 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $111 | $129 | $148 |