| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $5 | $7 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $5 | $7 | $11 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $5 | $7 |
| Allergy testing insect venoms CPT 95017 • Allergy | $5 | $7 | $11 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $6 | $20 | $30 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $1 | $8 | $11 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $9 | $11 | $12 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $8 | $11 | $14 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $5 | $9 | $14 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $59 | $261 | $362 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $59 | $261 | $362 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $45 | $50 | $59 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $59 | $181 | $241 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $59 | $301 | $422 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $45 | $216 | $543 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $45 | $50 | $59 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $45 | $155 | $362 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $59 | $382 | $543 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $45 | $196 | $483 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $59 | $261 | $362 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $59 | $341 | $483 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $59 | $261 | $362 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $95 | $705 | $1,264 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $168 | $1,244 | $2,230 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $45 | $1,033 | $2,711 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $1,517 | $3,341 | $5,316 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $338 | $2,048 | $3,554 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $89 | $437 | $776 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $99 | $602 | $863 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $14 | $20 | $24 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $6 | $9 | $12 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $1 | $10 | $16 |
| Cardiovascular stress test CPT 93015 • Cardiology | $55 | $111 | $175 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $26 | $37 | $48 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $69 | $128 | $184 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $12 | $124 | $237 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $50 | $72 | $94 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $125 | $239 | $491 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $28 | $286 | $596 |
| Stress echocardiography CPT 93350 • Cardiology | $30 | $198 | $467 |
| Left and right heart catheterization CPT 93452 • Cardiology | $439 | $631 | $824 |
| Left heart catheterization CPT 93458 • Cardiology | $287 | $388 | $441 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $281 | $1,408 | $2,845 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $123 | $170 | $290 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $13 | $50 | $119 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $181 | $260 | $313 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $142 | $202 | $280 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $4 | $22 | $37 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $7 | $43 | $84 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $77 | $109 | $140 |