| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $5 | $7 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $3 | $3 | $3 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $5 | $9 | $14 |
| Allergy testing insect venoms CPT 95017 • Allergy | $14 | $14 | $14 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $11 | $13 | $15 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $2 | $2 | $2 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $8 | $14 | $22 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $13 | $19 | $26 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $2 | $18 | $35 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $52 | $57 | $61 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $52 | $147 | $243 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $61 | $216 | $509 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $61 | $208 | $485 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $52 | $143 | $315 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $49 | $163 | $388 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $61 | $265 | $655 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $61 | $123 | $291 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $49 | $171 | $412 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $49 | $195 | $485 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $51 | $167 | $388 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $51 | $134 | $291 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $61 | $487 | $1,746 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $651 | $1,030 | $1,223 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,146 | $1,766 | $2,137 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $1,637 | $2,703 | $4,144 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $1,919 | $4,041 | $5,101 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,127 | $2,127 | $2,127 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $353 | $739 | $1,126 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $423 | $805 | $1,250 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $21 | $31 | $40 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $5 | $12 | $21 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $11 | $15 | $19 |
| Cardiovascular stress test CPT 93015 • Cardiology | $88 | $140 | $169 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $80 | $80 | $80 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $205 | $209 | $212 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $186 | $186 | $186 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $55 | $183 | $415 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $163 | $312 | $519 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $139 | $467 | $753 |
| Stress echocardiography CPT 93350 • Cardiology | $62 | $233 | $548 |
| Left and right heart catheterization CPT 93452 • Cardiology | $2,139 | $2,139 | $2,139 |
| Left heart catheterization CPT 93458 • Cardiology | $374 | $674 | $944 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $298 | $1,178 | $2,813 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $112 | $280 | $483 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $61 | $119 | $206 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $504 | $560 | $616 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $43 | $255 | $400 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $23 | $83 | $152 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $10 | $32 | $54 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $15 | $102 | $241 |