| Allergen specific IgE each allergen CPT 86003 • Allergy | $4 | $6 | $8 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $6 | $9 | $14 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $9 | $15 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $8 | $13 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $5 | $12 | $20 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $1 | $7 | $17 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $12 | $17 | $27 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $14 | $20 | $32 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $19 | $42 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $5 | $57 | $108 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $5 | $57 | $108 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $5 | $54 | $98 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $3 | $54 | $98 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $5 | $54 | $98 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $3 | $54 | $98 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $5 | $54 | $98 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $3 | $56 | $108 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $3 | $43 | $98 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $5 | $57 | $108 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $4 | $54 | $98 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $5 | $826 | $3,150 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $3 | $825 | $3,150 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $483 | $1,150 | $2,121 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $851 | $1,804 | $3,739 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $1,959 | $3,130 | $4,813 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,300 | $4,396 | $8,931 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,553 | $5,280 | $9,935 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $510 | $996 | $1,880 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $568 | $1,069 | $2,096 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $15 | $29 | $46 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $7 | $15 | $20 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $15 | $26 |
| Cardiovascular stress test CPT 93015 • Cardiology | $88 | $148 | $257 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $46 | $78 | $127 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $72 | $168 | $262 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $88 | $369 | $947 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $134 | $339 | $798 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $132 | $279 | $459 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $233 | $453 | $863 |
| Stress echocardiography CPT 93350 • Cardiology | $123 | $191 | $253 |
| Left and right heart catheterization CPT 93452 • Cardiology | $285 | $1,008 | $1,701 |
| Left heart catheterization CPT 93458 • Cardiology | $351 | $1,359 | $2,700 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $395 | $1,628 | $2,845 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $58 | $165 | $249 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $77 | $140 | $259 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $242 | $398 | $759 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $159 | $319 | $596 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $12 | $89 | $227 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $17 | $59 | $135 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $37 | $117 | $324 |