| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $4 | $5 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $5 | $6 | $7 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $6 | $9 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $9 | $18 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $6 | $13 | $18 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $5 | $9 | $17 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $1 | $10 | $20 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $5 | $14 | $23 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $2 | $14 | $31 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $40 | $236 | $579 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $95 | $418 | $579 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $40 | $238 | $579 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $40 | $174 | $386 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $40 | $270 | $676 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $95 | $611 | $869 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $40 | $268 | $676 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $40 | $58 | $95 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $40 | $58 | $95 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $40 | $56 | $89 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $40 | $56 | $89 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $40 | $58 | $95 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $40 | $238 | $579 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $484 | $1,192 | $1,900 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $839 | $2,091 | $3,344 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $1,296 | $4,034 | $6,771 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $1,015 | $4,485 | $7,955 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $339 | $4,604 | $8,869 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $247 | $679 | $1,111 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $549 | $778 | $1,235 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $3 | $20 | $36 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $9 | $14 | $18 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $13 | $17 |
| Cardiovascular stress test CPT 93015 • Cardiology | $38 | $93 | $147 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $43 | $57 | $72 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $43 | $114 | $186 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $64 | $114 | $164 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $33 | $91 | $130 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $193 | $274 | $436 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $51 | $171 | $292 |
| Stress echocardiography CPT 93350 • Cardiology | $83 | $241 | $398 |
| Left and right heart catheterization CPT 93452 • Cardiology | $239 | $407 | $493 |
| Left heart catheterization CPT 93458 • Cardiology | $294 | $530 | $678 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $331 | $1,054 | $1,777 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $26 | $165 | $346 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $26 | $37 | $47 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $25 | $285 | $546 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $30 | $191 | $419 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $5 | $33 | $57 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $19 | $42 | $83 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $5 | $73 | $140 |