| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $5 | $6 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $4 | $4 | $4 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $5 | $7 |
| Allergy testing insect venoms CPT 95017 • Allergy | $4 | $9 | $13 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $7 | $17 | $35 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $1 | $6 | $13 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $12 | $14 | $14 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $12 | $15 | $18 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $4 | $10 | $23 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $300 | $419 | $611 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $40 | $332 | $611 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $30 | $159 | $407 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $30 | $114 | $272 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $30 | $182 | $475 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $30 | $329 | $917 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $30 | $261 | $713 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $30 | $227 | $611 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $30 | $329 | $917 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $30 | $295 | $815 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $30 | $159 | $407 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $30 | $309 | $857 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $30 | $397 | $1,121 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $609 | $741 | $882 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $150 | $961 | $1,552 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $352 | $1,950 | $3,154 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $1,342 | $2,524 | $3,710 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $379 | $2,389 | $4,139 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $599 | $698 | $877 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $665 | $776 | $976 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $17 | $24 | $28 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $8 | $14 | $18 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $11 | $14 |
| Cardiovascular stress test CPT 93015 • Cardiology | $86 | $104 | $115 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $45 | $56 | $68 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $86 | $133 | $169 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $88 | $172 | $255 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $59 | $222 | $377 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $154 | $228 | $289 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $124 | $284 | $399 |
| Stress echocardiography CPT 93350 • Cardiology | $117 | $201 | $303 |
| Left and right heart catheterization CPT 93452 • Cardiology | $285 | $909 | $1,385 |
| Left heart catheterization CPT 93458 • Cardiology | $343 | $784 | $1,660 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $395 | $1,103 | $1,823 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $183 | $247 | $321 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $12 | $84 | $137 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $37 | $237 | $408 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $32 | $191 | $311 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $19 | $66 | $93 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $27 | $79 | $111 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $45 | $85 | $163 |