| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $3 | $4 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $4 | $6 | $7 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $8 | $11 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $7 | $10 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $21 | $21 | $22 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $5 | $8 | $12 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $9 | $12 | $15 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $10 | $15 | $17 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $8 | $19 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $35 | $169 | $496 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $35 | $153 | $521 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $63 | $206 | $602 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $35 | $162 | $451 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $35 | $204 | $620 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $52 | $179 | $510 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $43 | $126 | $300 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $35 | $275 | $1,133 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $35 | $211 | $659 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $30 | $154 | $533 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $30 | $163 | $595 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $35 | $201 | $510 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $35 | $120 | $311 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $513 | $612 | $710 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $911 | $1,136 | $1,254 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $413 | $1,605 | $2,546 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,182 | $2,798 | $3,872 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $42 | $1,238 | $2,433 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $458 | $492 | $525 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $485 | $587 | $692 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $15 | $17 | $19 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $5 | $10 | $16 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $11 | $13 |
| Cardiovascular stress test CPT 93015 • Cardiology | $69 | $95 | $120 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $32 | $38 | $43 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $85 | $92 | $101 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $160 | $286 | $386 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $64 | $196 | $311 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $73 | $138 | $240 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $30 | $193 | $491 |
| Stress echocardiography CPT 93350 • Cardiology | $30 | $112 | $183 |
| Left and right heart catheterization CPT 93452 • Cardiology | $236 | $533 | $830 |
| Left heart catheterization CPT 93458 • Cardiology | $387 | $517 | $733 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $465 | $939 | $1,568 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $40 | $50 | $58 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $13 | $62 | $111 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $57 | $197 | $330 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $58 | $90 | $152 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $60 | $69 | $78 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $23 | $73 | $122 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $96 | $115 | $134 |