| Allergen specific IgE each allergen CPT 86003 • Allergy | $4 | $4 | $5 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $1 | $5 | $8 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $6 | $8 | $11 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $6 | $10 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $18 | $31 | $56 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $7 | $12 | $22 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $8 | $17 | $27 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $1 | $17 | $32 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $11 | $21 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $42 | $567 | $1,480 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $42 | $438 | $962 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $104 | $569 | $888 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $42 | $403 | $1,036 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $42 | $519 | $1,184 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $101 | $840 | $1,332 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $42 | $602 | $2,220 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $42 | $401 | $814 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $42 | $629 | $1,406 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $104 | $788 | $1,332 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $42 | $677 | $1,924 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $42 | $694 | $1,776 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $42 | $1,172 | $4,500 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $119 | $905 | $1,988 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $517 | $2,010 | $3,504 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $42 | $2,460 | $7,129 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $246 | $3,692 | $8,370 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $42 | $3,132 | $9,311 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $102 | $912 | $1,721 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $425 | $1,131 | $1,918 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $3 | $22 | $40 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $2 | $10 | $17 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $1 | $12 | $23 |
| Cardiovascular stress test CPT 93015 • Cardiology | $33 | $116 | $235 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $35 | $76 | $117 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $40 | $128 | $240 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $35 | $323 | $867 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $211 | $446 | $730 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $54 | $265 | $652 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $42 | $220 | $359 |
| Stress echocardiography CPT 93350 • Cardiology | $43 | $249 | $617 |
| Left and right heart catheterization CPT 93452 • Cardiology | $597 | $1,400 | $2,202 |
| Left heart catheterization CPT 93458 • Cardiology | $541 | $1,407 | $3,432 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $324 | $1,333 | $2,604 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $35 | $165 | $420 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $16 | $118 | $226 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $68 | $246 | $662 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $30 | $80 | $136 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $40 | $41 | $42 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $25 | $116 | $208 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $26 | $147 | $257 |