| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $4 | $6 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $4 | $7 | $10 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $5 | $6 |
| Allergy testing insect venoms CPT 95017 • Allergy | $11 | $11 | $11 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $20 | $24 | $28 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $10 | $11 | $11 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $10 | $12 | $13 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $14 | $17 | $21 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $15 | $17 | $19 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $327 | $367 | $407 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $81 | $346 | $611 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $81 | $244 | $407 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $81 | $244 | $407 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $81 | $278 | $475 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $81 | $499 | $917 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $81 | $278 | $475 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $81 | $346 | $611 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $81 | $346 | $611 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $81 | $448 | $815 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $81 | $244 | $407 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $81 | $469 | $857 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $81 | $601 | $1,121 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $703 | $849 | $996 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $187 | $712 | $1,237 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $336 | $1,422 | $2,508 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,183 | $2,567 | $2,950 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $438 | $1,865 | $3,291 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $673 | $695 | $718 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $580 | $690 | $799 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $15 | $22 | $31 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $8 | $13 | $20 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $10 | $11 | $11 |
| Cardiovascular stress test CPT 93015 • Cardiology | $73 | $83 | $94 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $38 | $41 | $45 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $73 | $95 | $117 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $100 | $181 | $262 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $225 | $256 | $286 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $175 | $201 | $229 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $179 | $259 | $360 |
| Stress echocardiography CPT 93350 • Cardiology | $68 | $111 | $153 |
| Left and right heart catheterization CPT 93452 • Cardiology | $300 | $561 | $822 |
| Left heart catheterization CPT 93458 • Cardiology | $969 | $1,004 | $1,038 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $455 | $736 | $1,017 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $212 | $230 | $248 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $12 | $54 | $97 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $37 | $161 | $285 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $211 | $228 | $244 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $45 | $60 | $74 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $53 | $71 | $89 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $102 | $114 | $130 |