| Allergen specific IgE each allergen CPT 86003 • Allergy | $4 | $5 | $6 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $5 | $6 | $6 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $5 | $7 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $5 | $9 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $8 | $14 | $20 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $1 | $4 | $7 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $10 | $10 | $10 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $12 | $12 | $12 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $9 | $14 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $61 | $467 | $873 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $69 | $327 | $462 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $55 | $62 | $69 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $69 | $325 | $582 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $61 | $540 | $1,019 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $55 | $62 | $69 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $69 | $304 | $539 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $55 | $195 | $462 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $55 | $58 | $61 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $61 | $613 | $1,164 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $61 | $467 | $873 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $61 | $1,448 | $2,836 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $55 | $813 | $2,324 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $693 | $698 | $702 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $38 | $618 | $1,199 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,109 | $2,306 | $2,502 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,942 | $3,307 | $4,022 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $3,296 | $5,232 | $7,168 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $595 | $652 | $709 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $660 | $660 | $660 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $19 | $19 | $20 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $6 | $8 | $11 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $9 | $10 | $11 |
| Cardiovascular stress test CPT 93015 • Cardiology | $88 | $92 | $96 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $47 | $47 | $47 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $72 | $87 | $103 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $80 | $130 | $192 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $175 | $197 | $218 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $72 | $172 | $273 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $118 | $239 | $329 |
| Stress echocardiography CPT 93350 • Cardiology | $186 | $204 | $221 |
| Left and right heart catheterization CPT 93452 • Cardiology | $280 | $280 | $280 |
| Left heart catheterization CPT 93458 • Cardiology | $345 | $544 | $743 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $1,327 | $1,458 | $1,589 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $106 | $186 | $265 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $102 | $108 | $113 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $279 | $307 | $336 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $210 | $236 | $261 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $18 | $53 | $76 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $31 | $73 | $114 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $41 | $47 | $52 |