| Allergen specific IgE each allergen CPT 86003 • Allergy | $2 | $3 | $4 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $3 | $4 | $4 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $5 | $7 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $5 | $8 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $7 | $15 | $20 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $1 | $6 | $8 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $2 | $8 | $15 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $11 | $12 | $13 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $13 | $15 | $16 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $41 | $47 | $56 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $41 | $48 | $57 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $41 | $47 | $56 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $44 | $55 | $76 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $44 | $47 | $52 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $41 | $46 | $52 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $33 | $40 | $45 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $45 | $55 | $76 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $44 | $47 | $52 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $45 | $47 | $52 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $41 | $46 | $52 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $44 | $48 | $56 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $44 | $55 | $76 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $88 | $316 | $545 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $165 | $828 | $1,491 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $41 | $1,052 | $1,648 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $1,724 | $1,785 | $1,846 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $357 | $2,167 | $3,977 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $83 | $250 | $417 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $55 | $259 | $464 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $20 | $24 | $27 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $4 | $8 | $13 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $2 | $8 | $14 |
| Cardiovascular stress test CPT 93015 • Cardiology | $72 | $83 | $94 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $9 | $20 | $31 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $16 | $42 | $67 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $38 | $55 | $73 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $43 | $144 | $237 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $74 | $164 | $211 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $175 | $211 | $248 |
| Stress echocardiography CPT 93350 • Cardiology | $107 | $126 | $145 |
| Left and right heart catheterization CPT 93452 • Cardiology | $235 | $856 | $1,477 |
| Left heart catheterization CPT 93458 • Cardiology | $309 | $641 | $835 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $843 | $973 | $1,180 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $201 | $227 | $253 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $20 | $56 | $92 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $266 | $305 | $345 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $34 | $80 | $163 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $8 | $33 | $59 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $4 | $40 | $76 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $102 | $102 | $102 |