| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $4 | $6 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $4 | $5 | $7 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $7 | $15 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $7 | $13 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $6 | $12 | $18 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $5 | $7 | $10 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $8 | $12 | $14 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $10 | $15 | $18 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $4 | $12 | $19 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $30 | $167 | $407 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $30 | $235 | $611 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $30 | $167 | $407 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $30 | $122 | $272 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $30 | $190 | $475 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $30 | $337 | $917 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $30 | $190 | $475 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $30 | $235 | $611 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $64 | $630 | $917 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $30 | $303 | $815 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $30 | $167 | $407 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $64 | $1,030 | $1,739 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $64 | $936 | $1,623 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $413 | $794 | $1,237 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $458 | $939 | $1,181 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $1,493 | $2,083 | $2,412 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $1,104 | $1,812 | $2,519 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,648 | $2,938 | $3,245 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $419 | $8,424 | $32,052 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $466 | $8,478 | $32,052 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $12 | $27 | $42 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $5 | $11 | $18 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $7 | $10 | $11 |
| Cardiovascular stress test CPT 93015 • Cardiology | $59 | $90 | $112 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $31 | $49 | $68 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $59 | $100 | $169 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $81 | $146 | $210 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $130 | $180 | $231 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $105 | $174 | $260 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $107 | $274 | $387 |
| Stress echocardiography CPT 93350 • Cardiology | $151 | $194 | $246 |
| Left and right heart catheterization CPT 93452 • Cardiology | $187 | $552 | $918 |
| Left heart catheterization CPT 93458 • Cardiology | $833 | $1,423 | $2,315 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $264 | $982 | $1,445 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $154 | $214 | $249 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $9 | $73 | $108 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $30 | $204 | $315 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $126 | $201 | $245 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $19 | $44 | $94 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $27 | $68 | $135 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $103 | $113 | $123 |