| Allergen specific IgE each allergen CPT 86003 • Allergy | $4 | $6 | $7 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $7 | $8 | $9 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $7 | $12 | $17 |
| Allergy testing insect venoms CPT 95017 • Allergy | $20 | $20 | $20 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $52 | $52 | $52 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $11 | $15 | $20 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $12 | $17 | $22 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $14 | $20 | $26 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $8 | $13 | $17 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $95 | $441 | $732 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $95 | $450 | $732 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $95 | $449 | $732 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $95 | $291 | $488 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $95 | $458 | $854 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $95 | $870 | $1,416 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $95 | $656 | $1,019 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $95 | $450 | $732 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $95 | $617 | $1,098 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $95 | $542 | $976 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $95 | $405 | $732 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $95 | $527 | $976 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $95 | $1,008 | $2,474 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $102 | $736 | $1,455 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $102 | $1,291 | $2,529 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,580 | $4,050 | $5,144 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $485 | $4,233 | $6,055 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $6,754 | $6,754 | $6,754 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $1,265 | $1,385 | $1,505 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $742 | $1,273 | $1,671 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $22 | $33 | $43 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $10 | $18 | $23 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $12 | $17 | $22 |
| Cardiovascular stress test CPT 93015 • Cardiology | $74 | $153 | $193 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $44 | $71 | $98 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $219 | $224 | $229 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $164 | $175 | $197 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $102 | $282 | $432 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $130 | $263 | $495 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $102 | $200 | $457 |
| Stress echocardiography CPT 93350 • Cardiology | $99 | $129 | $184 |
| Left and right heart catheterization CPT 93452 • Cardiology | $1,558 | $1,710 | $1,862 |
| Left heart catheterization CPT 93458 • Cardiology | $524 | $1,324 | $1,885 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $465 | $2,016 | $3,025 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $50 | $174 | $406 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $16 | $149 | $240 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $103 | $250 | $330 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $61 | $283 | $497 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $69 | $94 | $120 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $147 | $147 | $147 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $50 | $172 | $251 |