| Allergen specific IgE each allergen CPT 86003 • Allergy | $4 | $6 | $7 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $6 | $6 | $7 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $5 | $10 | $15 |
| Allergy testing insect venoms CPT 95017 • Allergy | $4 | $11 | $18 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $20 | $34 | $47 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $7 | $12 | $18 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $9 | $15 | $24 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $11 | $20 | $30 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $12 | $20 | $30 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $45 | $326 | $606 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $45 | $411 | $606 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $40 | $296 | $606 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $40 | $221 | $404 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $45 | $419 | $707 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $45 | $592 | $909 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $40 | $362 | $707 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $40 | $374 | $606 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $40 | $536 | $909 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $45 | $490 | $808 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $40 | $419 | $606 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $45 | $422 | $808 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $40 | $729 | $1,746 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $504 | $823 | $1,237 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $869 | $1,396 | $2,174 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $317 | $2,455 | $4,439 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,145 | $4,197 | $5,223 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,390 | $4,110 | $5,831 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $512 | $686 | $860 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $569 | $655 | $742 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $18 | $26 | $42 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $10 | $16 | $27 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $11 | $15 |
| Cardiovascular stress test CPT 93015 • Cardiology | $74 | $120 | $178 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $48 | $48 | $48 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $93 | $105 | $117 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $158 | $159 | $160 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $81 | $253 | $545 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $93 | $252 | $526 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $139 | $395 | $573 |
| Stress echocardiography CPT 93350 • Cardiology | $90 | $294 | $555 |
| Left and right heart catheterization CPT 93452 • Cardiology | $242 | $277 | $312 |
| Left heart catheterization CPT 93458 • Cardiology | $297 | $619 | $1,185 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $335 | $1,299 | $2,567 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $52 | $167 | $244 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $12 | $101 | $203 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $27 | $351 | $594 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $43 | $246 | $452 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $19 | $59 | $110 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $53 | $53 | $53 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $37 | $106 | $180 |