| Allergen specific IgE each allergen CPT 86003 • Allergy | $2 | $4 | $6 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $2 | $5 | $8 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $4 | $4 |
| Allergy testing insect venoms CPT 95017 • Allergy | $4 | $6 | $8 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $7 | $10 | $17 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $1 | $5 | $8 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $9 | $11 | $14 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $11 | $15 | $20 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $2 | $7 | $16 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $40 | $232 | $420 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $40 | $179 | $420 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $40 | $198 | $420 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $40 | $141 | $280 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $40 | $233 | $490 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $40 | $284 | $630 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $40 | $227 | $490 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $40 | $198 | $420 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $40 | $293 | $630 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $40 | $256 | $560 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $40 | $232 | $420 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $40 | $231 | $560 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $40 | $232 | $420 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $554 | $665 | $731 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $975 | $1,135 | $1,250 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $360 | $1,561 | $2,344 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $423 | $1,757 | $2,519 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,114 | $2,453 | $2,648 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $556 | $574 | $599 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $619 | $638 | $665 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $18 | $24 | $28 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $7 | $11 | $18 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $9 | $11 | $14 |
| Cardiovascular stress test CPT 93015 • Cardiology | $74 | $98 | $112 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $35 | $51 | $68 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $73 | $112 | $169 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $88 | $125 | $173 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $175 | $213 | $232 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $183 | $250 | $314 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $118 | $232 | $328 |
| Stress echocardiography CPT 93350 • Cardiology | $72 | $125 | $184 |
| Left and right heart catheterization CPT 93452 • Cardiology | $247 | $262 | $285 |
| Left heart catheterization CPT 93458 • Cardiology | $351 | $852 | $1,132 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $395 | $679 | $824 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $172 | $206 | $238 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $13 | $59 | $103 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $218 | $250 | $267 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $198 | $210 | $231 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $17 | $23 | $32 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $27 | $42 | $70 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $42 | $47 | $52 |