| Allergen specific IgE each allergen CPT 86003 • Allergy | $2 | $4 | $5 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $2 | $5 | $8 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $5 | $7 | $11 |
| Allergy testing insect venoms CPT 95017 • Allergy | $8 | $9 | $11 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $7 | $32 | $58 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $7 | $12 | $23 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $1 | $15 | $29 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $5 | $21 | $33 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $4 | $7 | $10 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $109 | $524 | $732 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $109 | $524 | $732 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $109 | $524 | $732 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $98 | $358 | $488 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $109 | $606 | $854 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $98 | $765 | $1,098 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $33 | $328 | $854 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $109 | $524 | $732 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $98 | $765 | $1,098 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $109 | $687 | $976 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $109 | $524 | $732 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $109 | $687 | $976 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $109 | $524 | $732 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $263 | $1,238 | $2,214 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $61 | $1,981 | $3,902 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $122 | $2,468 | $4,813 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $287 | $4,804 | $9,321 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $1,119 | $5,743 | $10,368 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $101 | $1,032 | $1,962 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $280 | $1,234 | $2,187 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $17 | $32 | $48 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $2 | $11 | $21 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $18 | $28 |
| Cardiovascular stress test CPT 93015 • Cardiology | $76 | $172 | $268 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $41 | $87 | $133 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $94 | $184 | $274 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $79 | $534 | $988 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $49 | $142 | $236 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $172 | $218 | $264 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $193 | $342 | $491 |
| Stress echocardiography CPT 93350 • Cardiology | $178 | $309 | $440 |
| Left and right heart catheterization CPT 93452 • Cardiology | $900 | $1,706 | $2,511 |
| Left heart catheterization CPT 93458 • Cardiology | $802 | $1,810 | $2,818 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $1,204 | $2,708 | $4,212 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $129 | $150 | $171 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $93 | $161 | $229 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $37 | $81 | $126 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $112 | $142 | $171 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $4 | $120 | $237 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $3 | $138 | $274 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $8 | $67 | $127 |