| Allergen specific IgE each allergen CPT 86003 • Allergy | $2 | $2 | $2 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $3 | $5 | $7 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $5 | $7 | $12 |
| Allergy testing insect venoms CPT 95017 • Allergy | $9 | $16 | $29 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $27 | $47 | $68 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $11 | $16 | $26 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $17 | $17 | $17 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $18 | $30 | $43 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $6 | $18 | $28 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $53 | $62 | $71 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $72 | $228 | $306 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $72 | $219 | $306 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $53 | $79 | $113 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $53 | $62 | $72 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $71 | $265 | $459 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $68 | $251 | $357 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $72 | $220 | $306 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $53 | $166 | $376 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $53 | $134 | $278 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $53 | $107 | $196 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $52 | $106 | $212 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $53 | $122 | $311 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $687 | $1,224 | $1,762 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,034 | $1,422 | $1,810 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $42 | $794 | $1,545 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $1,816 | $2,503 | $2,847 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $8,310 | $8,310 | $8,310 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $438 | $438 | $438 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $860 | $1,421 | $1,982 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $19 | $25 | $32 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $8 | $12 | $16 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $10 | $14 | $16 |
| Cardiovascular stress test CPT 93015 • Cardiology | $93 | $153 | $252 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $73 | $85 | $97 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $90 | $122 | $171 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $145 | $146 | $146 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $447 | $447 | $447 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $108 | $350 | $669 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $169 | $408 | $803 |
| Stress echocardiography CPT 93350 • Cardiology | $233 | $246 | $259 |
| Left and right heart catheterization CPT 93452 • Cardiology | $192 | $243 | $294 |
| Left heart catheterization CPT 93458 • Cardiology | $445 | $654 | $863 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $939 | $1,272 | $1,605 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $35 | $107 | $179 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $18 | $57 | $112 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $57 | $268 | $412 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $304 | $324 | $345 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $42 | $71 | $121 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $109 | $116 | $122 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $185 | $185 | $185 |