| Allergen specific IgE each allergen CPT 86003 • Allergy | $4 | $4 | $6 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $3 | $5 | $6 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $6 | $10 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $8 | $11 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $5 | $20 | $26 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $5 | $13 | $20 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $9 | $18 | $36 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $16 | $28 | $46 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $4 | $16 | $24 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $6 | $96 | $282 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $6 | $96 | $282 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $6 | $96 | $282 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $6 | $105 | $188 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $6 | $107 | $329 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $6 | $131 | $423 |
| Anesthesia for upper GI endoscopy CPT 00740 • Anesthesia | $282 | $282 | $282 |
| Anesthesia for lower GI endoscopy CPT 00810 • Anesthesia | $282 | $282 | $282 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $6 | $107 | $329 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $6 | $96 | $282 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $6 | $369 | $981 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $6 | $125 | $400 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $6 | $96 | $282 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $6 | $469 | $1,337 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $6 | $720 | $2,161 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $661 | $915 | $1,531 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,112 | $1,542 | $2,261 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,344 | $3,689 | $4,639 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,519 | $4,182 | $5,451 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,156 | $3,279 | $5,204 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $510 | $817 | $1,328 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $520 | $669 | $842 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $27 | $37 | $53 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $8 | $22 | $42 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $11 | $17 | $21 |
| Cardiovascular stress test CPT 93015 • Cardiology | $71 | $107 | $133 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $49 | $73 | $101 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $94 | $172 | $232 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $107 | $210 | $336 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $71 | $220 | $290 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $75 | $226 | $379 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $257 | $298 | $328 |
| Stress echocardiography CPT 93350 • Cardiology | $49 | $139 | $184 |
| Left and right heart catheterization CPT 93452 • Cardiology | $920 | $1,052 | $1,210 |
| Left heart catheterization CPT 93458 • Cardiology | $283 | $1,062 | $1,479 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $908 | $1,283 | $1,633 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $85 | $239 | $353 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $34 | $88 | $109 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $199 | $341 | $584 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $149 | $251 | $382 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $15 | $45 | $126 |