| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $4 | $5 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $2 | $3 | $4 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $6 | $7 |
| Allergy testing insect venoms CPT 95017 • Allergy | $7 | $9 | $10 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $10 | $17 | $24 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $1 | $3 | $5 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $8 | $11 | $15 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $9 | $11 | $12 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $6 | $9 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $49 | $228 | $407 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $38 | $165 | $407 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $49 | $228 | $407 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $49 | $228 | $407 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $38 | $187 | $475 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $38 | $334 | $917 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $49 | $262 | $475 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $38 | $233 | $611 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $38 | $233 | $611 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $38 | $300 | $815 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $38 | $233 | $611 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $49 | $453 | $857 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $38 | $589 | $1,682 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $529 | $763 | $899 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $212 | $1,076 | $1,588 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $294 | $2,022 | $3,210 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $511 | $2,727 | $3,768 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,236 | $3,257 | $4,194 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $509 | $636 | $763 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $566 | $769 | $918 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $17 | $21 | $24 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $10 | $11 | $12 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $11 | $13 |
| Cardiovascular stress test CPT 93015 • Cardiology | $89 | $95 | $107 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $37 | $42 | $52 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $104 | $107 | $108 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $80 | $211 | $402 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $93 | $112 | $130 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $79 | $221 | $318 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $183 | $306 | $384 |
| Stress echocardiography CPT 93350 • Cardiology | $115 | $232 | $302 |
| Left and right heart catheterization CPT 93452 • Cardiology | $552 | $761 | $970 |
| Left heart catheterization CPT 93458 • Cardiology | $287 | $1,105 | $1,721 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $338 | $841 | $1,266 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $201 | $213 | $224 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $11 | $93 | $128 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $225 | $271 | $317 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $162 | $210 | $277 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $28 | $70 | $128 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $24 | $65 | $146 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $36 | $110 | $180 |