| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $4 | $4 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $5 | $5 | $7 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $4 | $6 |
| Allergy testing insect venoms CPT 95017 • Allergy | $6 | $11 | $20 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $5 | $17 | $31 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $6 | $11 | $19 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $6 | $10 | $15 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $8 | $14 | $22 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $2 | $15 | $31 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $45 | $160 | $496 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $45 | $166 | $521 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $45 | $166 | $520 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $45 | $142 | $425 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $45 | $142 | $425 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $45 | $160 | $496 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $45 | $151 | $460 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $45 | $123 | $347 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $45 | $211 | $700 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $45 | $215 | $714 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $45 | $175 | $555 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $45 | $147 | $442 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $45 | $219 | $730 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $512 | $621 | $769 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $905 | $1,062 | $1,243 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $413 | $1,663 | $2,609 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $485 | $1,736 | $2,988 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $3,278 | $3,278 | $3,278 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $380 | $530 | $832 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $596 | $730 | $924 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $9 | $19 | $32 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $4 | $10 | $19 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $5 | $9 | $12 |
| Cardiovascular stress test CPT 93015 • Cardiology | $46 | $87 | $135 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $23 | $43 | $82 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $50 | $121 | $192 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $89 | $96 | $109 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $109 | $191 | $311 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $102 | $285 | $723 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $69 | $182 | $376 |
| Stress echocardiography CPT 93350 • Cardiology | $80 | $120 | $156 |
| Left and right heart catheterization CPT 93452 • Cardiology | $1,210 | $1,210 | $1,210 |
| Left heart catheterization CPT 93458 • Cardiology | $489 | $606 | $705 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $206 | $495 | $759 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $70 | $160 | $274 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $64 | $100 | $150 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $38 | $234 | $378 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $173 | $242 | $364 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $12 | $41 | $57 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $22 | $50 | $65 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $28 | $94 | $137 |