| Allergen specific IgE each allergen CPT 86003 • Allergy | $2 | $2 | $2 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $3 | $3 | $3 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $5 | $7 | $10 |
| Allergy testing insect venoms CPT 95017 • Allergy | $10 | $15 | $24 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $20 | $23 | $27 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $3 | $9 | $13 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $15 | $19 | $27 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $13 | $21 | $32 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $4 | $15 | $21 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $104 | $678 | $1,480 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $104 | $492 | $962 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $65 | $468 | $888 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $65 | $467 | $1,036 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $104 | $555 | $1,036 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $65 | $691 | $1,332 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $104 | $950 | $2,220 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $101 | $528 | $1,110 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $104 | $802 | $1,628 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $101 | $678 | $1,332 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $104 | $653 | $1,406 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $104 | $827 | $1,776 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $101 | $546 | $1,184 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $665 | $901 | $1,118 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,163 | $1,565 | $1,967 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,593 | $4,861 | $7,129 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $3,009 | $3,589 | $4,706 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $3,407 | $6,359 | $9,311 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $549 | $654 | $758 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $841 | $1,270 | $1,918 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $22 | $30 | $40 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $10 | $14 | $17 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $12 | $16 | $23 |
| Cardiovascular stress test CPT 93015 • Cardiology | $103 | $156 | $235 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $47 | $56 | $64 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $99 | $164 | $240 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $96 | $452 | $867 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $111 | $220 | $323 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $276 | $366 | $537 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $190 | $280 | $383 |
| Stress echocardiography CPT 93350 • Cardiology | $124 | $256 | $386 |
| Left and right heart catheterization CPT 93452 • Cardiology | $326 | $635 | $945 |
| Left heart catheterization CPT 93458 • Cardiology | $405 | $636 | $961 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $475 | $1,003 | $1,531 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $69 | $190 | $278 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $21 | $121 | $226 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $53 | $152 | $334 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $60 | $119 | $204 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $20 | $103 | $181 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $28 | $42 | $57 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $126 | $166 | $215 |