| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $4 | $5 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $4 | $6 | $8 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $8 | $11 |
| Allergy testing insect venoms CPT 95017 • Allergy | $9 | $10 | $11 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $7 | $32 | $58 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $1 | $12 | $23 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $2 | $15 | $29 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $11 | $22 | $33 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $10 | $13 | $15 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $44 | $401 | $732 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $98 | $573 | $732 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $44 | $401 | $732 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $109 | $393 | $488 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $44 | $462 | $854 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $98 | $848 | $1,098 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $98 | $665 | $854 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $109 | $576 | $732 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $109 | $851 | $1,098 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $98 | $756 | $976 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $98 | $573 | $732 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $109 | $759 | $976 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $98 | $573 | $732 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $44 | $1,129 | $2,214 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $44 | $1,973 | $3,902 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $330 | $2,571 | $4,813 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $258 | $4,790 | $9,321 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $574 | $5,471 | $10,368 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $74 | $1,018 | $1,962 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $82 | $1,135 | $2,187 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $3 | $25 | $48 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $1 | $11 | $21 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $18 | $28 |
| Cardiovascular stress test CPT 93015 • Cardiology | $72 | $170 | $268 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $37 | $85 | $133 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $78 | $176 | $274 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $139 | $564 | $988 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $173 | $503 | $833 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $138 | $201 | $264 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $49 | $230 | $410 |
| Stress echocardiography CPT 93350 • Cardiology | $68 | $254 | $440 |
| Left and right heart catheterization CPT 93452 • Cardiology | $747 | $813 | $880 |
| Left heart catheterization CPT 93458 • Cardiology | $833 | $965 | $1,096 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $1,193 | $2,081 | $2,969 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $201 | $352 | $502 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $43 | $136 | $229 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $51 | $422 | $792 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $40 | $331 | $622 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $7 | $30 | $54 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $59 | $166 | $274 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $17 | $72 | $127 |