| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $4 | $4 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $6 | $6 | $7 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $3 | $4 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $5 | $9 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $17 | $19 | $20 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $1 | $7 | $13 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $8 | $11 | $15 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $10 | $13 | $17 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $2 | $12 | $21 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $30 | $518 | $1,480 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $30 | $270 | $962 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $30 | $321 | $888 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $44 | $285 | $740 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $44 | $384 | $1,036 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $30 | $469 | $1,332 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $44 | $335 | $888 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $30 | $252 | $888 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $30 | $567 | $1,628 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $44 | $483 | $1,332 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $30 | $370 | $1,036 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $30 | $617 | $1,776 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $30 | $326 | $1,184 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $577 | $720 | $920 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,002 | $1,083 | $1,163 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $1,565 | $2,253 | $2,941 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $1,839 | $2,464 | $2,778 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,713 | $2,713 | $2,713 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $445 | $445 | $445 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $591 | $641 | $691 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $16 | $18 | $21 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $5 | $9 | $14 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $7 | $10 | $15 |
| Cardiovascular stress test CPT 93015 • Cardiology | $68 | $84 | $112 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $33 | $35 | $36 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $73 | $104 | $153 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $64 | $157 | $386 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $162 | $279 | $396 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $153 | $219 | $253 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $201 | $221 | $236 |
| Stress echocardiography CPT 93350 • Cardiology | $124 | $179 | $228 |
| Left and right heart catheterization CPT 93452 • Cardiology | $550 | $730 | $910 |
| Left heart catheterization CPT 93458 • Cardiology | $277 | $446 | $631 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $507 | $768 | $1,123 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $38 | $133 | $231 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $83 | $109 | $149 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $207 | $273 | $298 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $35 | $182 | $285 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $13 | $49 | $74 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $19 | $52 | $85 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $32 | $95 | $157 |