| Allergen specific IgE each allergen CPT 86003 • Allergy | $6 | $7 | $7 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $6 | $7 | $9 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $6 | $10 |
| Allergy testing insect venoms CPT 95017 • Allergy | $6 | $8 | $10 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $32 | $40 | $49 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $6 | $9 | $13 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $9 | $12 | $15 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $11 | $13 | $17 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $17 | $20 | $22 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $62 | $279 | $496 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $37 | $160 | $283 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $62 | $332 | $602 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $37 | $173 | $310 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $45 | $180 | $315 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $45 | $278 | $510 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $37 | $576 | $1,116 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $62 | $239 | $416 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $40 | $321 | $602 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $45 | $394 | $743 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $40 | $166 | $291 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $40 | $275 | $510 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $45 | $1,259 | $2,474 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $604 | $734 | $864 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,146 | $1,433 | $1,876 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,164 | $2,758 | $3,806 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $485 | $2,401 | $3,444 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $4,062 | $4,530 | $4,998 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $1,161 | $1,472 | $1,782 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $803 | $960 | $1,051 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $14 | $21 | $27 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $10 | $13 | $15 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $11 | $14 |
| Cardiovascular stress test CPT 93015 • Cardiology | $62 | $99 | $128 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $43 | $75 | $121 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $62 | $130 | $181 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $164 | $288 | $535 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $81 | $124 | $186 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $278 | $324 | $364 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $159 | $250 | $397 |
| Stress echocardiography CPT 93350 • Cardiology | $124 | $244 | $385 |
| Left and right heart catheterization CPT 93452 • Cardiology | $791 | $915 | $1,038 |
| Left heart catheterization CPT 93458 • Cardiology | $431 | $1,347 | $2,356 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $424 | $1,372 | $1,954 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $81 | $190 | $280 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $84 | $112 | $141 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $41 | $179 | $330 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $60 | $70 | $89 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $26 | $76 | $126 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $74 | $82 | $89 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $56 | $135 | $214 |