| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $6 | $8 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $6 | $13 | $20 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $5 | $8 | $12 |
| Allergy testing insect venoms CPT 95017 • Allergy | $6 | $12 | $21 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $24 | $28 | $32 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $1 | $6 | $10 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $9 | $16 | $22 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $11 | $14 | $16 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $4 | $4 | $5 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $95 | $233 | $371 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $42 | $290 | $732 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $59 | $215 | $371 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $59 | $153 | $247 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $58 | $308 | $433 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $59 | $415 | $630 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $95 | $264 | $433 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $42 | $157 | $371 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $42 | $220 | $556 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $58 | $349 | $494 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $47 | $263 | $371 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $47 | $271 | $494 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $95 | $279 | $371 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $507 | $666 | $823 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $30 | $1,162 | $2,294 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $1,818 | $2,286 | $2,754 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $3,054 | $3,194 | $3,474 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $3,407 | $4,854 | $6,301 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $758 | $797 | $836 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $573 | $751 | $929 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $19 | $20 | $21 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $8 | $17 | $25 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $11 | $16 | $21 |
| Cardiovascular stress test CPT 93015 • Cardiology | $69 | $129 | $221 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $126 | $126 | $126 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $95 | $114 | $132 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $96 | $103 | $118 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $168 | $259 | $349 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $260 | $310 | $359 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $313 | $356 | $383 |
| Stress echocardiography CPT 93350 • Cardiology | $173 | $180 | $184 |
| Left and right heart catheterization CPT 93452 • Cardiology | $1,003 | $1,003 | $1,003 |
| Left heart catheterization CPT 93458 • Cardiology | $287 | $950 | $1,614 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $1,120 | $1,441 | $1,757 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $38 | $44 | $50 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $108 | $166 | $224 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $50 | $209 | $315 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $44 | $144 | $245 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $21 | $48 | $63 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $74 | $92 | $109 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $101 | $113 | $126 |