| Allergen specific IgE each allergen CPT 86003 • Allergy | $4 | $5 | $7 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $5 | $5 | $5 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $5 | $11 | $15 |
| Allergy testing insect venoms CPT 95017 • Allergy | $9 | $9 | $10 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $24 | $35 | $47 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $9 | $13 | $18 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $10 | $14 | $20 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $12 | $15 | $26 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $14 | $16 | $17 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $62 | $334 | $606 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $62 | $379 | $606 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $62 | $304 | $606 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $62 | $212 | $404 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $62 | $435 | $707 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $62 | $536 | $909 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $62 | $628 | $1,116 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $55 | $241 | $606 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $55 | $328 | $783 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $62 | $513 | $808 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $62 | $370 | $606 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $62 | $387 | $808 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $62 | $734 | $1,746 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $651 | $871 | $1,237 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $62 | $802 | $1,199 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $317 | $2,482 | $3,872 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,958 | $4,068 | $5,223 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $3,296 | $4,181 | $5,066 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $595 | $728 | $860 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $630 | $677 | $742 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $18 | $27 | $42 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $9 | $16 | $27 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $9 | $12 | $15 |
| Cardiovascular stress test CPT 93015 • Cardiology | $88 | $125 | $178 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $41 | $44 | $47 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $96 | $99 | $103 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $119 | $148 | $192 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $64 | $97 | $146 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $137 | $293 | $526 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $139 | $300 | $573 |
| Stress echocardiography CPT 93350 • Cardiology | $90 | $318 | $555 |
| Left and right heart catheterization CPT 93452 • Cardiology | $289 | $634 | $980 |
| Left heart catheterization CPT 93458 • Cardiology | $345 | $686 | $1,339 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $388 | $1,313 | $2,567 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $208 | $267 | $329 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $16 | $102 | $203 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $44 | $357 | $594 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $171 | $259 | $369 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $22 | $68 | $110 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $55 | $67 | $79 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $52 | $112 | $180 |