| Allergen specific IgE each allergen CPT 86003 • Allergy | $2 | $2 | $2 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $2 | $3 | $3 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $5 | $7 |
| Allergy testing insect venoms CPT 95017 • Allergy | $7 | $9 | $10 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $6 | $13 | $24 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $6 | $8 | $9 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $9 | $10 | $12 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $2 | $7 | $11 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $7 | $14 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $33 | $39 | $50 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $31 | $34 | $38 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $33 | $35 | $38 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $31 | $33 | $34 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $33 | $35 | $38 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $33 | $39 | $50 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $33 | $36 | $38 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $31 | $34 | $38 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $34 | $37 | $38 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $33 | $35 | $38 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $31 | $33 | $34 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $33 | $35 | $38 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $33 | $36 | $38 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $55 | $366 | $573 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $878 | $913 | $947 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $201 | $1,127 | $2,053 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $332 | $1,588 | $2,330 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $1,230 | $1,960 | $2,691 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $52 | $265 | $478 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $64 | $298 | $531 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $11 | $16 | $22 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $3 | $8 | $13 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $7 | $9 | $9 |
| Cardiovascular stress test CPT 93015 • Cardiology | $55 | $77 | $109 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $33 | $56 | $69 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $26 | $80 | $132 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $73 | $82 | $86 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $127 | $179 | $226 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $74 | $184 | $296 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $77 | $217 | $357 |
| Stress echocardiography CPT 93350 • Cardiology | $149 | $186 | $232 |
| Left and right heart catheterization CPT 93452 • Cardiology | $750 | $869 | $1,001 |
| Left heart catheterization CPT 93458 • Cardiology | $325 | $736 | $943 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $1,032 | $1,145 | $1,268 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $35 | $115 | $196 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $74 | $118 | $142 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $29 | $163 | $246 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $44 | $149 | $221 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $2 | $35 | $67 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $13 | $46 | $80 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $42 | $60 | $77 |