| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $4 | $5 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $3 | $5 | $6 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $4 | $6 |
| Allergy testing insect venoms CPT 95017 • Allergy | $5 | $7 | $9 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $5 | $16 | $28 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $3 | $7 | $10 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $7 | $10 | $12 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $8 | $12 | $16 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $14 | $44 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $31 | $438 | $1,690 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $40 | $354 | $975 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $40 | $510 | $1,625 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $40 | $164 | $455 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $40 | $277 | $780 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $40 | $536 | $1,495 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $40 | $501 | $1,430 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $40 | $349 | $780 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $40 | $412 | $1,365 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $31 | $164 | $546 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $40 | $121 | $350 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $40 | $777 | $2,450 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $40 | $621 | $2,450 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $410 | $590 | $725 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $46 | $777 | $1,275 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $46 | $1,984 | $3,092 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $275 | $2,040 | $3,072 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,856 | $3,019 | $3,428 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $564 | $1,311 | $3,373 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $541 | $705 | $1,063 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $11 | $18 | $30 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $5 | $14 | $34 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $7 | $10 | $17 |
| Cardiovascular stress test CPT 93015 • Cardiology | $56 | $150 | $472 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $43 | $95 | $224 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $58 | $75 | $114 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $91 | $217 | $562 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $175 | $503 | $1,598 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $66 | $194 | $320 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $102 | $278 | $735 |
| Stress echocardiography CPT 93350 • Cardiology | $66 | $134 | $207 |
| Left and right heart catheterization CPT 93452 • Cardiology | $346 | $828 | $1,185 |
| Left heart catheterization CPT 93458 • Cardiology | $276 | $679 | $978 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $263 | $1,057 | $1,517 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $37 | $131 | $202 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $12 | $81 | $140 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $165 | $274 | $445 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $31 | $102 | $198 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $40 | $60 | $82 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $40 | $87 | $126 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $45 | $72 | $101 |