| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $4 | $4 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $2 | $3 | $5 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $5 | $6 | $9 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $10 | $17 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $24 | $36 | $42 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $6 | $13 | $17 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $10 | $19 | $27 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $2 | $19 | $33 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $6 | $27 | $45 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $33 | $65 | $124 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $87 | $721 | $1,038 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $39 | $67 | $124 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $33 | $53 | $87 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $33 | $51 | $87 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $34 | $574 | $1,557 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $39 | $458 | $1,211 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $39 | $70 | $132 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $39 | $576 | $1,557 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $33 | $53 | $87 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $33 | $401 | $1,038 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $33 | $66 | $132 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $33 | $66 | $132 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $34 | $671 | $1,407 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $496 | $1,486 | $2,477 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $34 | $3,336 | $4,995 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,330 | $4,062 | $5,848 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $34 | $3,276 | $6,517 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $574 | $928 | $1,282 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $1,072 | $1,355 | $1,568 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $19 | $24 | $30 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $12 | $13 | $15 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $9 | $11 | $14 |
| Cardiovascular stress test CPT 93015 • Cardiology | $109 | $141 | $177 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $68 | $86 | $102 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $132 | $168 | $225 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $86 | $126 | $204 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $153 | $321 | $480 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $74 | $182 | $296 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $238 | $286 | $357 |
| Stress echocardiography CPT 93350 • Cardiology | $91 | $268 | $481 |
| Left and right heart catheterization CPT 93452 • Cardiology | $431 | $1,026 | $2,075 |
| Left heart catheterization CPT 93458 • Cardiology | $824 | $1,963 | $2,746 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $1,268 | $2,178 | $2,985 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $66 | $302 | $456 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $132 | $138 | $142 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $50 | $110 | $215 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $44 | $146 | $351 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $8 | $58 | $122 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $40 | $81 | $143 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $7 | $101 | $194 |