| Allergen specific IgE each allergen CPT 86003 • Allergy | $4 | $4 | $4 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $5 | $7 | $9 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $6 | $8 | $11 |
| Allergy testing insect venoms CPT 95017 • Allergy | $8 | $9 | $9 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $22 | $40 | $58 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $7 | $11 | $14 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $12 | $17 | $27 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $14 | $22 | $28 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $15 | $23 | $35 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $32 | $200 | $496 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $32 | $99 | $272 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $32 | $210 | $520 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $32 | $128 | $283 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $32 | $272 | $564 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $70 | $509 | $885 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $78 | $370 | $523 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $32 | $102 | $267 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $30 | $312 | $602 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $78 | $422 | $597 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $32 | $256 | $555 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $32 | $211 | $531 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $32 | $299 | $730 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $590 | $701 | $813 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,243 | $1,370 | $1,619 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,580 | $4,105 | $5,209 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $485 | $1,954 | $2,449 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $3,794 | $3,794 | $3,794 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $544 | $636 | $728 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $803 | $826 | $850 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $15 | $20 | $23 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $11 | $13 | $14 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $12 | $15 |
| Cardiovascular stress test CPT 93015 • Cardiology | $96 | $104 | $120 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $44 | $49 | $56 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $109 | $175 | $242 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $79 | $106 | $160 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $87 | $206 | $311 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $102 | $209 | $283 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $124 | $238 | $337 |
| Stress echocardiography CPT 93350 • Cardiology | $97 | $175 | $219 |
| Left and right heart catheterization CPT 93452 • Cardiology | $339 | $339 | $339 |
| Left heart catheterization CPT 93458 • Cardiology | $524 | $1,726 | $2,929 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $465 | $751 | $1,200 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $151 | $251 | $337 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $113 | $114 | $116 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $190 | $290 | $349 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $47 | $146 | $330 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $31 | $83 | $173 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $25 | $39 | $53 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $106 | $120 | $134 |