| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $3 | $4 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $6 | $6 | $6 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $6 | $6 | $7 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $6 | $8 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $7 | $16 | $21 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $7 | $7 | $8 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $2 | $7 | $10 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $2 | $8 | $13 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $9 | $13 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $17 | $39 | $59 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $4 | $32 | $41 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $4 | $32 | $41 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $3 | $31 | $41 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $17 | $35 | $41 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $17 | $36 | $45 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $5 | $32 | $41 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $4 | $32 | $41 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $7 | $32 | $41 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $17 | $35 | $41 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $17 | $36 | $45 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $41 | $47 | $59 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $41 | $42 | $45 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $78 | $295 | $513 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $451 | $660 | $869 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $41 | $927 | $1,828 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $428 | $1,292 | $2,157 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $1,667 | $2,029 | $2,390 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $48 | $346 | $512 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $80 | $393 | $569 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $4 | $11 | $18 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $8 | $10 | $11 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $2 | $5 | $8 |
| Cardiovascular stress test CPT 93015 • Cardiology | $19 | $44 | $69 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $11 | $39 | $57 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $85 | $85 | $85 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $75 | $118 | $160 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $152 | $188 | $216 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $63 | $180 | $239 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $248 | $272 | $297 |
| Stress echocardiography CPT 93350 • Cardiology | $43 | $57 | $71 |
| Left and right heart catheterization CPT 93452 • Cardiology | $235 | $443 | $858 |
| Left heart catheterization CPT 93458 • Cardiology | $725 | $752 | $779 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $326 | $709 | $1,092 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $40 | $108 | $190 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $12 | $18 | $23 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $162 | $203 | $244 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $32 | $97 | $162 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $3 | $34 | $54 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $13 | $33 | $53 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $36 | $66 | $125 |