| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $5 | $6 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $4 | $7 | $10 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $5 | $10 | $15 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $12 | $21 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $10 | $22 | $50 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $2 | $13 | $21 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $9 | $17 | $24 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $18 | $23 | $29 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $14 | $27 | $38 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $62 | $319 | $600 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $62 | $384 | $779 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $62 | $319 | $600 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $62 | $269 | $520 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $62 | $441 | $909 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $62 | $459 | $900 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $62 | $365 | $700 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $62 | $384 | $779 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $62 | $461 | $909 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $62 | $412 | $800 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $62 | $319 | $600 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $62 | $817 | $1,689 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $60 | $713 | $1,472 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $459 | $1,058 | $1,274 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,284 | $1,807 | $2,241 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $421 | $3,078 | $4,569 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $1,948 | $3,979 | $5,369 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $5,154 | $5,702 | $5,989 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $739 | $1,017 | $1,277 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $694 | $1,066 | $1,421 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $25 | $35 | $42 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $7 | $13 | $19 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $12 | $16 | $20 |
| Cardiovascular stress test CPT 93015 • Cardiology | $84 | $140 | $167 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $54 | $70 | $88 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $136 | $166 | $205 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $177 | $301 | $387 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $86 | $351 | $541 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $97 | $241 | $327 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $283 | $317 | $338 |
| Stress echocardiography CPT 93350 • Cardiology | $266 | $303 | $375 |
| Left and right heart catheterization CPT 93452 • Cardiology | $211 | $1,198 | $1,769 |
| Left heart catheterization CPT 93458 • Cardiology | $411 | $1,797 | $2,484 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $465 | $1,309 | $2,705 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $219 | $300 | $389 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $15 | $93 | $176 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $282 | $433 | $585 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $222 | $312 | $393 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $14 | $107 | $188 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $31 | $127 | $213 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $80 | $170 | $263 |