| Allergen specific IgE each allergen CPT 86003 • Allergy | $4 | $5 | $6 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $6 | $7 | $9 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $6 | $10 |
| Allergy testing insect venoms CPT 95017 • Allergy | $9 | $9 | $9 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $23 | $23 | $23 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $5 | $8 | $11 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $9 | $13 | $15 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $12 | $15 | $17 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $9 | $21 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $62 | $402 | $643 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $62 | $486 | $752 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $62 | $415 | $643 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $62 | $267 | $428 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $62 | $665 | $1,184 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $62 | $814 | $1,416 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $62 | $424 | $750 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $62 | $506 | $814 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $62 | $885 | $1,628 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $30 | $164 | $533 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $30 | $323 | $643 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $62 | $476 | $857 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $62 | $1,735 | $4,500 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $756 | $838 | $920 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,243 | $1,278 | $1,313 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $413 | $1,533 | $2,653 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $3,111 | $3,492 | $3,872 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $3,464 | $3,464 | $3,464 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $777 | $777 | $777 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $552 | $822 | $1,051 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $23 | $25 | $27 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $14 | $15 | $16 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $13 | $14 | $15 |
| Cardiovascular stress test CPT 93015 • Cardiology | $120 | $124 | $128 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $44 | $58 | $72 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $146 | $149 | $153 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $224 | $224 | $224 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $282 | $339 | $396 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $98 | $291 | $537 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $30 | $229 | $430 |
| Stress echocardiography CPT 93350 • Cardiology | $30 | $124 | $172 |
| Left and right heart catheterization CPT 93452 • Cardiology | $859 | $859 | $859 |
| Left heart catheterization CPT 93458 • Cardiology | $541 | $864 | $1,075 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $465 | $821 | $1,177 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $43 | $110 | $220 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $17 | $47 | $104 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $68 | $237 | $406 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $61 | $202 | $330 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $61 | $61 | $61 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $74 | $74 | $74 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $134 | $137 | $139 |