| Allergen specific IgE each allergen CPT 86003 • Allergy | $2 | $5 | $7 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $3 | $5 | $6 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $5 | $7 |
| Allergy testing insect venoms CPT 95017 • Allergy | $6 | $9 | $11 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $17 | $25 | $34 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $1 | $3 | $6 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $9 | $13 | $17 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $11 | $16 | $19 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $15 | $25 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $60 | $396 | $732 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $79 | $406 | $732 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $60 | $293 | $732 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $88 | $225 | $488 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $60 | $338 | $854 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $100 | $455 | $1,098 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $60 | $387 | $854 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $100 | $421 | $732 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $80 | $452 | $1,098 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $60 | $394 | $976 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $60 | $330 | $732 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $100 | $401 | $976 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $100 | $465 | $732 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $812 | $890 | $1,039 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,357 | $1,400 | $1,443 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,797 | $2,867 | $2,937 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $3,445 | $3,447 | $3,448 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $3,828 | $3,832 | $3,836 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $823 | $849 | $875 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $975 | $1,052 | $1,172 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $25 | $29 | $34 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $10 | $16 | $21 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $13 | $14 | $16 |
| Cardiovascular stress test CPT 93015 • Cardiology | $62 | $101 | $126 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $59 | $77 | $95 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $59 | $129 | $204 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $243 | $365 | $440 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $125 | $282 | $371 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $108 | $293 | $400 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $91 | $221 | $402 |
| Stress echocardiography CPT 93350 • Cardiology | $295 | $304 | $314 |
| Left and right heart catheterization CPT 93452 • Cardiology | $1,045 | $1,082 | $1,119 |
| Left heart catheterization CPT 93458 • Cardiology | $458 | $767 | $1,256 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $666 | $1,492 | $1,934 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $66 | $233 | $390 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $113 | $139 | $166 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $171 | $299 | $403 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $67 | $208 | $299 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $26 | $50 | $63 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $36 | $61 | $78 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $61 | $97 | $161 |