| Allergen specific IgE each allergen CPT 86003 • Allergy | $4 | $8 | $14 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $6 | $13 | $21 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $5 | $11 | $15 |
| Allergy testing insect venoms CPT 95017 • Allergy | $6 | $10 | $18 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $35 | $39 | $42 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $16 | $16 | $16 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $11 | $18 | $24 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $13 | $21 | $26 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $7 | $12 | $17 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $84 | $312 | $540 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $63 | $232 | $540 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $66 | $372 | $540 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $66 | $215 | $360 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $84 | $422 | $630 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $84 | $516 | $810 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $66 | $450 | $655 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $84 | $368 | $606 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $84 | $522 | $810 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $84 | $496 | $720 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $84 | $432 | $582 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $84 | $365 | $720 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $63 | $599 | $1,746 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $651 | $997 | $1,334 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,146 | $1,734 | $2,351 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $57 | $2,605 | $4,793 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $4,651 | $5,167 | $5,627 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $3,046 | $4,652 | $6,259 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $1,453 | $1,453 | $1,453 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $742 | $1,258 | $1,620 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $21 | $28 | $37 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $9 | $12 | $16 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $11 | $15 | $21 |
| Cardiovascular stress test CPT 93015 • Cardiology | $74 | $143 | $196 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $41 | $70 | $98 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $126 | $163 | $201 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $292 | $441 | $725 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $81 | $260 | $439 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $120 | $229 | $353 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $139 | $324 | $414 |
| Stress echocardiography CPT 93350 • Cardiology | $90 | $286 | $405 |
| Left and right heart catheterization CPT 93452 • Cardiology | $274 | $461 | $648 |
| Left heart catheterization CPT 93458 • Cardiology | $374 | $563 | $808 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $424 | $1,836 | $3,098 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $50 | $207 | $385 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $16 | $124 | $181 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $96 | $353 | $529 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $43 | $234 | $476 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $39 | $90 | $141 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $44 | $44 | $44 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $50 | $102 | $180 |