| Allergen specific IgE each allergen CPT 86003 • Allergy | $1 | $3 | $6 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $4 | $7 | $10 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $5 | $8 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $6 | $12 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $7 | $20 | $32 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $1 | $7 | $12 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $1 | $7 | $14 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $11 | $13 | $16 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $15 | $17 | $20 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $44 | $56 | $80 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $44 | $56 | $80 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $44 | $56 | $80 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $44 | $56 | $80 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $44 | $56 | $80 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $44 | $56 | $80 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $44 | $56 | $80 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $44 | $56 | $80 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $44 | $56 | $80 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $44 | $56 | $80 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $44 | $56 | $80 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $44 | $56 | $80 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $44 | $56 | $80 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $44 | $431 | $817 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $550 | $994 | $1,438 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $220 | $1,569 | $2,919 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $387 | $1,911 | $3,434 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $430 | $2,375 | $3,826 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $74 | $467 | $835 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $82 | $506 | $929 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $7 | $17 | $26 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $6 | $10 | $13 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $4 | $8 | $13 |
| Cardiovascular stress test CPT 93015 • Cardiology | $72 | $91 | $109 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $37 | $45 | $52 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $16 | $77 | $139 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $70 | $94 | $119 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $61 | $164 | $370 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $112 | $152 | $206 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $106 | $137 | $168 |
| Stress echocardiography CPT 93350 • Cardiology | $127 | $168 | $209 |
| Left and right heart catheterization CPT 93452 • Cardiology | $374 | $560 | $747 |
| Left heart catheterization CPT 93458 • Cardiology | $833 | $1,194 | $1,554 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $529 | $861 | $1,193 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $38 | $145 | $252 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $74 | $95 | $116 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $128 | $265 | $402 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $99 | $182 | $250 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $13 | $17 | $25 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $4 | $38 | $90 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $14 | $83 | $151 |