| Allergen specific IgE each allergen CPT 86003 • Allergy | $2 | $2 | $3 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $1 | $4 | $5 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $5 | $6 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $8 | $12 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $6 | $18 | $30 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $2 | $5 | $7 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $1 | $7 | $14 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $2 | $9 | $16 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $6 | $11 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $40 | $41 | $42 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $34 | $39 | $42 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $34 | $38 | $40 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $40 | $48 | $63 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $40 | $41 | $42 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $40 | $288 | $782 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $40 | $41 | $42 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $40 | $48 | $63 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $40 | $287 | $782 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $40 | $259 | $696 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $40 | $41 | $42 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $40 | $41 | $42 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $40 | $41 | $42 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $42 | $445 | $700 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $63 | $647 | $1,231 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $42 | $1,548 | $2,512 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,460 | $2,624 | $2,952 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $274 | $1,783 | $3,292 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $255 | $535 | $815 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $85 | $496 | $906 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $15 | $17 | $22 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $2 | $7 | $12 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $4 | $7 | $11 |
| Cardiovascular stress test CPT 93015 • Cardiology | $66 | $93 | $110 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $7 | $29 | $51 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $80 | $110 | $130 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $14 | $66 | $115 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $48 | $154 | $342 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $102 | $175 | $221 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $40 | $171 | $268 |
| Stress echocardiography CPT 93350 • Cardiology | $212 | $240 | $276 |
| Left and right heart catheterization CPT 93452 • Cardiology | $264 | $731 | $1,365 |
| Left heart catheterization CPT 93458 • Cardiology | $682 | $989 | $1,603 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $507 | $1,062 | $1,608 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $136 | $200 | $263 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $80 | $93 | $104 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $49 | $90 | $169 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $44 | $75 | $136 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $40 | $66 | $91 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $42 | $74 | $107 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $129 | $137 | $146 |