| Allergen specific IgE each allergen CPT 86003 • Allergy | $2 | $4 | $5 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $8 | $8 | $8 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $7 | $10 | $12 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $14 | $26 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $22 | $41 | $59 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $13 | $18 | $23 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $15 | $22 | $29 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $13 | $21 | $34 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $21 | $33 | $44 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $109 | $795 | $1,480 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $33 | $368 | $962 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $59 | $474 | $888 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $109 | $388 | $666 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $35 | $426 | $1,184 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $35 | $475 | $1,332 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $59 | $1,140 | $2,220 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $33 | $302 | $814 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $35 | $587 | $1,628 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $35 | $492 | $1,332 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $35 | $517 | $1,406 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $59 | $918 | $1,776 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $35 | $1,548 | $4,500 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $30 | $1,055 | $2,214 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $2,618 | $2,618 | $2,618 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $30 | $2,422 | $4,813 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $1,433 | $3,844 | $6,254 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $6,957 | $6,957 | $6,957 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $1,962 | $1,962 | $1,962 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $1,051 | $1,511 | $1,971 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $29 | $36 | $43 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $7 | $14 | $21 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $15 | $20 | $25 |
| Cardiovascular stress test CPT 93015 • Cardiology | $78 | $150 | $242 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $40 | $80 | $120 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $153 | $200 | $247 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $79 | $485 | $890 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $396 | $467 | $537 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $154 | $196 | $238 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $211 | $473 | $901 |
| Stress echocardiography CPT 93350 • Cardiology | $30 | $183 | $396 |
| Left and right heart catheterization CPT 93452 • Cardiology | $880 | $880 | $880 |
| Left heart catheterization CPT 93458 • Cardiology | $541 | $1,540 | $2,539 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $1,237 | $1,956 | $2,675 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $337 | $453 | $569 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $37 | $93 | $149 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $68 | $151 | $270 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $60 | $260 | $459 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $30 | $115 | $199 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $230 | $230 | $230 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $157 | $248 | $338 |