| Allergen specific IgE each allergen CPT 86003 • Allergy | $4 | $4 | $4 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $5 | $7 | $9 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $6 | $7 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $8 | $13 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $9 | $16 | $22 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $6 | $8 | $11 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $9 | $11 | $13 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $11 | $16 | $23 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $4 | $10 | $13 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $32 | $41 | $50 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $33 | $57 | $89 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $32 | $57 | $88 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $32 | $57 | $88 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $32 | $64 | $109 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $48 | $88 | $167 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $32 | $74 | $129 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $32 | $61 | $119 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $32 | $87 | $178 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $48 | $82 | $147 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $32 | $67 | $108 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $32 | $70 | $128 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $32 | $586 | $2,219 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $590 | $638 | $686 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,023 | $1,143 | $1,263 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,528 | $2,528 | $2,528 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,448 | $2,636 | $3,010 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $3,356 | $3,356 | $3,356 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $573 | $679 | $785 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $810 | $810 | $810 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $9 | $17 | $23 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $11 | $16 | $22 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $10 | $11 |
| Cardiovascular stress test CPT 93015 • Cardiology | $62 | $85 | $96 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $46 | $53 | $60 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $59 | $123 | $201 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $79 | $129 | $243 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $67 | $193 | $319 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $99 | $161 | $243 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $91 | $238 | $337 |
| Stress echocardiography CPT 93350 • Cardiology | $219 | $239 | $259 |
| Left and right heart catheterization CPT 93452 • Cardiology | $873 | $881 | $889 |
| Left heart catheterization CPT 93458 • Cardiology | $335 | $370 | $405 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $1,200 | $1,209 | $1,218 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $136 | $194 | $274 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $59 | $111 | $159 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $39 | $133 | $190 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $33 | $39 | $45 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $48 | $54 | $60 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $42 | $55 | $70 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $70 | $106 | $143 |