| Allergen specific IgE each allergen CPT 86003 • Allergy | $5 | $6 | $7 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $8 | $9 | $11 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $6 | $10 |
| Allergy testing insect venoms CPT 95017 • Allergy | $4 | $6 | $8 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $7 | $7 | $7 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $12 | $15 | $19 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $21 | $21 | $21 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $11 | $18 | $24 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $16 | $28 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $85 | $253 | $420 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $62 | $281 | $420 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $85 | $261 | $420 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $62 | $152 | $280 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $85 | $355 | $490 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $30 | $240 | $630 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $85 | $278 | $422 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $30 | $177 | $420 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $62 | $425 | $630 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $62 | $346 | $560 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $62 | $275 | $420 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $62 | $268 | $560 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $60 | $303 | $420 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $659 | $803 | $875 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,254 | $1,748 | $2,241 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $42 | $1,250 | $2,459 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,702 | $4,463 | $5,369 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $3,328 | $4,659 | $5,989 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $678 | $708 | $738 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $588 | $956 | $1,421 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $15 | $23 | $30 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $19 | $23 | $27 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $11 | $13 |
| Cardiovascular stress test CPT 93015 • Cardiology | $115 | $158 | $175 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $52 | $79 | $108 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $90 | $174 | $251 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $177 | $247 | $387 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $249 | $310 | $371 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $87 | $173 | $307 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $169 | $353 | $488 |
| Stress echocardiography CPT 93350 • Cardiology | $78 | $220 | $291 |
| Left and right heart catheterization CPT 93452 • Cardiology | $324 | $455 | $586 |
| Left heart catheterization CPT 93458 • Cardiology | $414 | $877 | $1,771 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $449 | $1,647 | $2,845 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $54 | $69 | $96 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $88 | $138 | $197 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $57 | $224 | $330 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $34 | $154 | $345 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $40 | $59 | $69 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $24 | $68 | $122 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $37 | $66 | $95 |