| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $6 | $8 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $4 | $7 | $12 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $6 | $12 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $8 | $12 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $7 | $15 | $31 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $1 | $8 | $12 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $10 | $12 | $14 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $12 | $14 | $18 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $4 | $13 | $22 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $42 | $203 | $649 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $42 | $194 | $611 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $30 | $191 | $611 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $57 | $138 | $272 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $30 | $216 | $713 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $30 | $267 | $917 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $30 | $157 | $475 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $30 | $200 | $649 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $57 | $407 | $897 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $30 | $174 | $543 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $57 | $200 | $611 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $30 | $252 | $857 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $30 | $318 | $1,121 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $512 | $731 | $1,382 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $884 | $1,198 | $2,441 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $275 | $1,906 | $2,792 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,271 | $3,095 | $5,224 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $359 | $3,133 | $8,163 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $552 | $632 | $780 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $566 | $762 | $1,395 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $13 | $21 | $36 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $6 | $11 | $22 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $7 | $11 | $20 |
| Cardiovascular stress test CPT 93015 • Cardiology | $67 | $109 | $181 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $40 | $56 | $67 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $71 | $125 | $195 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $89 | $257 | $405 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $56 | $196 | $264 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $192 | $284 | $516 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $97 | $273 | $619 |
| Stress echocardiography CPT 93350 • Cardiology | $110 | $227 | $489 |
| Left and right heart catheterization CPT 93452 • Cardiology | $273 | $840 | $1,260 |
| Left heart catheterization CPT 93458 • Cardiology | $296 | $895 | $2,816 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $378 | $1,103 | $3,027 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $35 | $228 | $472 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $12 | $110 | $201 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $37 | $245 | $598 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $175 | $256 | $464 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $42 | $73 | $106 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $35 | $105 | $209 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $41 | $106 | $149 |