| Allergen specific IgE each allergen CPT 86003 • Allergy | $4 | $6 | $7 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $4 | $5 | $6 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $5 | $10 | $15 |
| Allergy testing insect venoms CPT 95017 • Allergy | $5 | $10 | $18 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $16 | $26 | $35 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $10 | $13 | $16 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $11 | $16 | $24 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $13 | $19 | $26 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $7 | $14 | $17 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $45 | $94 | $142 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $61 | $362 | $606 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $142 | $476 | $679 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $45 | $137 | $218 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $45 | $270 | $609 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $61 | $535 | $909 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $45 | $359 | $970 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $61 | $367 | $606 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $149 | $563 | $909 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $45 | $322 | $696 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $45 | $323 | $582 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $45 | $202 | $412 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $45 | $775 | $2,474 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $483 | $805 | $1,182 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,146 | $1,531 | $2,174 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $45 | $1,581 | $3,238 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,048 | $3,490 | $5,223 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $3,567 | $4,699 | $5,831 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $860 | $949 | $1,038 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $742 | $791 | $841 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $13 | $18 | $25 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $6 | $9 | $14 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $6 | $11 | $16 |
| Cardiovascular stress test CPT 93015 • Cardiology | $60 | $98 | $145 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $31 | $48 | $66 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $72 | $120 | $168 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $60 | $73 | $99 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $45 | $103 | $183 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $180 | $222 | $271 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $139 | $293 | $573 |
| Stress echocardiography CPT 93350 • Cardiology | $90 | $214 | $405 |
| Left and right heart catheterization CPT 93452 • Cardiology | $206 | $502 | $798 |
| Left heart catheterization CPT 93458 • Cardiology | $374 | $906 | $1,437 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $424 | $924 | $1,873 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $50 | $266 | $465 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $70 | $102 | $133 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $76 | $238 | $433 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $43 | $152 | $369 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $69 | $88 | $110 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $71 | $71 | $71 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $74 | $131 | $216 |