| Allergen specific IgE each allergen CPT 86003 • Allergy | $4 | $5 | $9 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $10 | $14 | $18 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $5 | $7 |
| Allergy testing insect venoms CPT 95017 • Allergy | $6 | $8 | $9 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $6 | $8 | $10 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $5 | $8 | $11 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $9 | $12 | $14 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $11 | $14 | $18 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $2 | $8 | $19 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $62 | $372 | $559 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $62 | $366 | $559 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $102 | $421 | $602 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $62 | $295 | $451 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $33 | $338 | $652 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $33 | $383 | $900 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $102 | $351 | $652 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $62 | $382 | $559 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $33 | $424 | $900 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $30 | $164 | $533 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $33 | $302 | $559 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $62 | $439 | $745 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $102 | $471 | $730 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $701 | $1,049 | $1,995 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,243 | $2,008 | $3,468 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $413 | $1,998 | $2,885 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $485 | $4,710 | $8,277 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $3,669 | $3,669 | $3,669 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $777 | $777 | $777 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $817 | $1,081 | $1,386 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $22 | $31 | $42 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $14 | $15 | $16 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $12 | $16 | $24 |
| Cardiovascular stress test CPT 93015 • Cardiology | $115 | $140 | $162 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $40 | $54 | $72 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $116 | $177 | $211 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $211 | $237 | $276 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $236 | $273 | $311 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $102 | $257 | $430 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $158 | $510 | $894 |
| Stress echocardiography CPT 93350 • Cardiology | $30 | $195 | $304 |
| Left and right heart catheterization CPT 93452 • Cardiology | $859 | $1,418 | $1,977 |
| Left heart catheterization CPT 93458 • Cardiology | $458 | $1,033 | $1,532 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $465 | $1,609 | $2,604 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $265 | $384 | $608 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $17 | $77 | $110 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $330 | $389 | $493 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $254 | $292 | $330 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $65 | $83 | $120 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $41 | $41 | $41 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $134 | $149 | $164 |