| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $5 | $7 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $4 | $7 | $11 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $8 | $8 | $9 |
| Allergy testing insect venoms CPT 95017 • Allergy | $9 | $12 | $15 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $23 | $31 | $38 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $2 | $5 | $8 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $12 | $14 | $16 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $15 | $17 | $19 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $4 | $15 | $26 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $68 | $215 | $362 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $68 | $290 | $440 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $68 | $254 | $440 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $68 | $155 | $241 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $65 | $244 | $422 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $65 | $304 | $543 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $68 | $291 | $514 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $68 | $290 | $440 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $68 | $306 | $543 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $65 | $481 | $896 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $68 | $215 | $362 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $68 | $276 | $483 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $68 | $663 | $1,560 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $1,003 | $1,133 | $1,264 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,300 | $1,533 | $1,765 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $3,590 | $3,590 | $3,590 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $4,218 | $4,849 | $5,316 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $4,704 | $4,704 | $4,704 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $969 | $969 | $969 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $844 | $961 | $1,078 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $30 | $34 | $39 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $9 | $12 | $15 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $15 | $17 | $19 |
| Cardiovascular stress test CPT 93015 • Cardiology | $127 | $151 | $175 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $37 | $49 | $60 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $158 | $171 | $184 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $80 | $148 | $283 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $115 | $256 | $397 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $371 | $431 | $491 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $243 | $538 | $775 |
| Stress echocardiography CPT 93350 • Cardiology | $128 | $298 | $467 |
| Left and right heart catheterization CPT 93452 • Cardiology | $432 | $509 | $586 |
| Left heart catheterization CPT 93458 • Cardiology | $539 | $1,118 | $1,698 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $1,481 | $2,163 | $2,845 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $285 | $285 | $285 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $151 | $151 | $152 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $383 | $452 | $520 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $62 | $200 | $338 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $94 | $102 | $119 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $31 | $86 | $140 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $134 | $161 | $189 |