| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $4 | $4 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $5 | $6 | $7 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $5 | $7 |
| Allergy testing insect venoms CPT 95017 • Allergy | $4 | $5 | $5 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $10 | $20 | $28 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $1 | $5 | $8 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $11 | $13 | $16 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $13 | $15 | $18 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $8 | $16 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $52 | $769 | $1,820 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $52 | $388 | $738 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $52 | $388 | $738 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $52 | $502 | $1,230 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $52 | $613 | $1,265 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $52 | $1,177 | $2,880 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $52 | $495 | $984 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $52 | $372 | $690 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $52 | $529 | $935 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $52 | $575 | $1,148 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $52 | $580 | $1,312 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $52 | $753 | $1,142 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $52 | $1,036 | $1,886 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $348 | $437 | $526 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $525 | $3,229 | $7,952 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $1,351 | $1,360 | $1,369 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $1,566 | $1,716 | $1,867 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $1,566 | $1,566 | $1,566 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $620 | $4,070 | $8,502 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $613 | $3,805 | $13,078 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $15 | $20 | $25 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $7 | $10 | $14 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $10 | $13 | $17 |
| Cardiovascular stress test CPT 93015 • Cardiology | $90 | $112 | $153 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $44 | $59 | $76 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $67 | $99 | $130 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $177 | $294 | $473 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $199 | $239 | $265 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $110 | $218 | $294 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $172 | $238 | $304 |
| Stress echocardiography CPT 93350 • Cardiology | $71 | $123 | $151 |
| Left and right heart catheterization CPT 93452 • Cardiology | $300 | $1,989 | $3,880 |
| Left heart catheterization CPT 93458 • Cardiology | $441 | $775 | $942 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $501 | $2,077 | $3,880 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $60 | $172 | $286 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $16 | $73 | $110 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $32 | $206 | $360 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $173 | $231 | $293 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $58 | $66 | $81 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $59 | $72 | $93 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $115 | $149 | $170 |