| Allergen specific IgE each allergen CPT 86003 • Allergy | $4 | $7 | $11 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $11 | $14 | $17 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $7 | $8 | $9 |
| Allergy testing insect venoms CPT 95017 • Allergy | $8 | $11 | $13 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $15 | $26 | $35 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $12 | $14 | $16 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $13 | $17 | $22 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $16 | $19 | $26 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $6 | $12 | $23 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $79 | $495 | $1,079 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $79 | $495 | $1,079 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $30 | $276 | $719 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $30 | $196 | $480 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $30 | $316 | $839 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $30 | $396 | $1,079 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $30 | $316 | $839 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $30 | $396 | $1,079 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $79 | $730 | $1,618 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $30 | $356 | $959 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $30 | $396 | $1,079 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $30 | $356 | $959 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $30 | $276 | $719 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $723 | $1,039 | $1,212 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $474 | $1,100 | $1,552 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,580 | $4,236 | $6,974 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $1,147 | $2,628 | $3,710 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $1,274 | $2,778 | $3,687 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $729 | $1,190 | $1,963 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $811 | $1,247 | $1,954 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $14 | $34 | $54 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $9 | $15 | $24 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $11 | $18 | $30 |
| Cardiovascular stress test CPT 93015 • Cardiology | $98 | $162 | $273 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $48 | $82 | $143 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $110 | $172 | $263 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $85 | $396 | $998 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $239 | $473 | $802 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $187 | $257 | $332 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $195 | $357 | $479 |
| Stress echocardiography CPT 93350 • Cardiology | $172 | $385 | $681 |
| Left and right heart catheterization CPT 93452 • Cardiology | $871 | $1,090 | $1,385 |
| Left heart catheterization CPT 93458 • Cardiology | $1,144 | $2,173 | $3,716 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $460 | $1,171 | $1,823 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $225 | $351 | $507 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $102 | $153 | $221 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $100 | $270 | $408 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $227 | $346 | $499 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $42 | $78 | $98 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $79 | $94 | $112 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $145 | $154 | $163 |