| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $5 | $7 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $4 | $8 | $11 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $5 | $10 | $15 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $14 | $21 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $10 | $28 | $50 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $2 | $14 | $21 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $9 | $18 | $24 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $18 | $23 | $29 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $8 | $23 | $38 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $62 | $294 | $600 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $62 | $335 | $779 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $60 | $294 | $600 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $62 | $231 | $520 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $62 | $382 | $909 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $62 | $426 | $900 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $62 | $338 | $700 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $62 | $335 | $779 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $62 | $427 | $909 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $62 | $382 | $800 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $60 | $294 | $600 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $62 | $614 | $1,689 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $60 | $500 | $1,472 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $459 | $1,147 | $1,274 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,284 | $1,990 | $2,241 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $421 | $3,705 | $4,569 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $1,948 | $4,560 | $5,369 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $5,154 | $5,805 | $5,989 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $739 | $1,137 | $1,308 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $694 | $1,228 | $1,455 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $25 | $36 | $42 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $7 | $14 | $19 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $12 | $17 | $20 |
| Cardiovascular stress test CPT 93015 • Cardiology | $84 | $154 | $175 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $54 | $75 | $88 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $136 | $177 | $205 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $177 | $318 | $387 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $86 | $324 | $553 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $97 | $322 | $491 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $283 | $434 | $596 |
| Stress echocardiography CPT 93350 • Cardiology | $266 | $370 | $467 |
| Left and right heart catheterization CPT 93452 • Cardiology | $211 | $1,644 | $2,301 |
| Left heart catheterization CPT 93458 • Cardiology | $411 | $1,610 | $2,645 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $465 | $1,948 | $2,845 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $96 | $259 | $389 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $15 | $108 | $176 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $282 | $463 | $585 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $83 | $267 | $393 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $14 | $115 | $188 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $31 | $137 | $213 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $80 | $183 | $263 |