| Allergen specific IgE each allergen CPT 86003 • Allergy | $4 | $6 | $7 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $6 | $9 | $11 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $10 | $15 |
| Allergy testing insect venoms CPT 95017 • Allergy | $8 | $14 | $18 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $14 | $23 | $35 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $14 | $16 | $18 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $16 | $18 | $20 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $19 | $22 | $26 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $7 | $15 | $24 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $30 | $90 | $149 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $142 | $451 | $606 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $149 | $378 | $606 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $30 | $90 | $149 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $30 | $263 | $609 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $149 | $614 | $909 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $142 | $274 | $406 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $30 | $262 | $606 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $142 | $611 | $909 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $30 | $292 | $696 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $30 | $234 | $522 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $30 | $90 | $149 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $30 | $234 | $522 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $532 | $872 | $1,182 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $938 | $1,496 | $2,054 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $30 | $2,503 | $4,242 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,251 | $4,154 | $5,223 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $5,560 | $5,560 | $5,560 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $860 | $949 | $1,038 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $1,152 | $1,152 | $1,152 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $14 | $23 | $31 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $6 | $10 | $15 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $12 | $16 |
| Cardiovascular stress test CPT 93015 • Cardiology | $69 | $118 | $145 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $32 | $51 | $71 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $75 | $122 | $168 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $21 | $147 | $312 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $30 | $235 | $439 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $196 | $247 | $298 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $202 | $338 | $573 |
| Stress echocardiography CPT 93350 • Cardiology | $186 | $345 | $445 |
| Left and right heart catheterization CPT 93452 • Cardiology | $239 | $927 | $1,615 |
| Left heart catheterization CPT 93458 • Cardiology | $508 | $555 | $602 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $678 | $1,121 | $1,873 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $292 | $336 | $380 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $80 | $110 | $139 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $76 | $250 | $433 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $59 | $63 | $67 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $64 | $93 | $110 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $74 | $100 | $127 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $74 | $82 | $89 |