| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $5 | $6 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $5 | $6 | $6 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $6 | $8 |
| Allergy testing insect venoms CPT 95017 • Allergy | $4 | $10 | $14 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $8 | $28 | $41 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $5 | $10 | $16 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $14 | $18 | $21 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $18 | $22 | $27 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $4 | $15 | $28 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $40 | $290 | $540 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $40 | $290 | $540 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $40 | $290 | $540 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $40 | $200 | $360 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $40 | $335 | $630 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $40 | $425 | $810 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $40 | $335 | $630 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $40 | $290 | $540 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $40 | $511 | $981 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $40 | $380 | $720 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $40 | $290 | $540 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $40 | $380 | $720 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $40 | $290 | $540 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $731 | $891 | $1,111 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,181 | $1,526 | $1,953 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,344 | $3,153 | $4,019 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $30 | $1,955 | $3,317 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,377 | $2,843 | $3,504 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $599 | $863 | $1,143 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $665 | $959 | $1,272 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $28 | $34 | $37 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $16 | $19 | $24 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $11 | $14 | $17 |
| Cardiovascular stress test CPT 93015 • Cardiology | $112 | $134 | $150 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $64 | $75 | $92 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $169 | $189 | $228 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $88 | $99 | $109 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $100 | $260 | $450 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $289 | $360 | $402 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $209 | $339 | $480 |
| Stress echocardiography CPT 93350 • Cardiology | $184 | $255 | $368 |
| Left and right heart catheterization CPT 93452 • Cardiology | $310 | $841 | $1,309 |
| Left heart catheterization CPT 93458 • Cardiology | $381 | $1,204 | $2,101 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $429 | $1,506 | $2,290 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $238 | $321 | $385 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $19 | $95 | $164 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $267 | $371 | $488 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $53 | $220 | $376 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $19 | $37 | $63 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $27 | $54 | $80 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $47 | $137 | $196 |