| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $4 | $4 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $2 | $3 | $4 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $5 | $10 | $15 |
| Allergy testing insect venoms CPT 95017 • Allergy | $9 | $10 | $12 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $24 | $37 | $62 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $3 | $6 | $11 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $5 | $22 | $44 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $2 | $23 | $47 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $10 | $26 | $42 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $33 | $152 | $500 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $34 | $98 | $283 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $33 | $162 | $542 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $33 | $140 | $408 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $33 | $133 | $425 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $33 | $248 | $885 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $33 | $328 | $1,204 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $33 | $239 | $850 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $33 | $177 | $602 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $33 | $166 | $555 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $33 | $175 | $595 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $33 | $137 | $442 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $33 | $209 | $730 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $86 | $687 | $1,401 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $149 | $1,701 | $2,950 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $1,007 | $3,730 | $6,310 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $620 | $2,796 | $5,904 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $1,291 | $5,270 | $7,934 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $431 | $1,015 | $1,599 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $96 | $892 | $1,778 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $22 | $29 | $50 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $13 | $16 | $24 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $5 | $13 | $25 |
| Cardiovascular stress test CPT 93015 • Cardiology | $55 | $123 | $208 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $34 | $95 | $205 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $132 | $194 | $256 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $17 | $196 | $484 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $170 | $295 | $484 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $74 | $173 | $296 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $36 | $318 | $722 |
| Stress echocardiography CPT 93350 • Cardiology | $156 | $240 | $339 |
| Left and right heart catheterization CPT 93452 • Cardiology | $658 | $765 | $923 |
| Left heart catheterization CPT 93458 • Cardiology | $325 | $486 | $892 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $465 | $924 | $1,268 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $34 | $213 | $457 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $110 | $151 | $207 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $108 | $346 | $732 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $183 | $297 | $563 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $14 | $103 | $164 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $33 | $87 | $193 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $9 | $55 | $105 |