| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $3 | $3 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $11 | $11 | $11 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $8 | $10 |
| Allergy testing insect venoms CPT 95017 • Allergy | $9 | $13 | $20 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $48 | $51 | $53 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $11 | $16 | $19 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $12 | $20 | $27 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $14 | $23 | $31 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $19 | $30 | $36 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $65 | $336 | $496 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $40 | $215 | $448 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $90 | $360 | $542 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $65 | $192 | $299 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $65 | $384 | $564 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $65 | $411 | $672 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $65 | $337 | $523 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $40 | $357 | $850 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $90 | $447 | $672 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $65 | $399 | $597 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $90 | $375 | $587 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $90 | $376 | $597 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $40 | $321 | $730 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $1,268 | $1,294 | $1,319 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,243 | $2,822 | $4,991 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,580 | $5,804 | $10,308 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $620 | $5,242 | $12,121 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $5,897 | $6,038 | $6,179 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $1,166 | $1,254 | $1,342 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $803 | $1,197 | $1,493 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $23 | $33 | $41 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $14 | $17 | $21 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $12 | $17 | $21 |
| Cardiovascular stress test CPT 93015 • Cardiology | $96 | $151 | $178 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $44 | $87 | $121 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $174 | $231 | $289 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $133 | $333 | $671 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $87 | $340 | $543 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $102 | $434 | $723 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $158 | $339 | $568 |
| Stress echocardiography CPT 93350 • Cardiology | $250 | $331 | $449 |
| Left and right heart catheterization CPT 93452 • Cardiology | $523 | $1,098 | $1,674 |
| Left heart catheterization CPT 93458 • Cardiology | $403 | $1,514 | $2,356 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $465 | $1,887 | $2,616 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $87 | $249 | $396 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $30 | $115 | $203 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $100 | $339 | $587 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $74 | $140 | $259 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $38 | $77 | $126 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $63 | $141 | $218 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $95 | $110 | $134 |