| 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 | $5 | $7 | $12 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $5 | $7 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $10 | $22 | $37 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $2 | $8 | $14 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $11 | $16 | $21 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $13 | $19 | $23 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $13 | $24 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $42 | $78 | $142 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $42 | $242 | $540 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $90 | $371 | $540 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $42 | $194 | $404 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $42 | $135 | $364 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $85 | $517 | $909 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $90 | $417 | $707 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $85 | $333 | $606 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $42 | $146 | $412 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $90 | $467 | $808 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $42 | $181 | $582 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $42 | $418 | $808 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $42 | $634 | $1,746 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $59 | $622 | $1,182 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $55 | $1,085 | $2,054 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $39 | $1,663 | $4,242 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $44 | $2,497 | $4,987 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $42 | $1,882 | $5,560 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $102 | $803 | $1,268 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $567 | $968 | $1,411 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $15 | $26 | $39 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $7 | $13 | $19 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $7 | $12 | $16 |
| Cardiovascular stress test CPT 93015 • Cardiology | $66 | $110 | $158 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $7 | $39 | $71 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $16 | $88 | $168 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $14 | $132 | $312 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $81 | $240 | $545 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $147 | $246 | $421 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $139 | $305 | $613 |
| Stress echocardiography CPT 93350 • Cardiology | $90 | $177 | $307 |
| Left and right heart catheterization CPT 93452 • Cardiology | $564 | $762 | $1,125 |
| Left heart catheterization CPT 93458 • Cardiology | $374 | $1,146 | $1,974 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $424 | $1,062 | $2,181 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $52 | $254 | $465 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $16 | $104 | $181 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $169 | $348 | $500 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $193 | $291 | $403 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $42 | $64 | $103 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $54 | $90 | $127 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $42 | $128 | $216 |