| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $5 | $7 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $3 | $5 | $7 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $5 | $10 | $15 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $11 | $18 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $7 | $21 | $35 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $8 | $9 | $10 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $11 | $16 | $24 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $13 | $21 | $30 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $11 | $17 | $22 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $35 | $44 | $52 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $35 | $270 | $606 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $35 | $98 | $218 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $35 | $129 | $291 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $35 | $266 | $609 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $52 | $533 | $909 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $60 | $474 | $707 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $52 | $377 | $606 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $35 | $322 | $783 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $35 | $318 | $696 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $35 | $282 | $522 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $35 | $160 | $388 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $35 | $589 | $1,746 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $536 | $674 | $902 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,064 | $1,105 | $1,146 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $64 | $1,996 | $3,238 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,219 | $3,401 | $5,223 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $3,544 | $3,808 | $4,072 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $469 | $579 | $688 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $620 | $924 | $1,411 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $20 | $22 | $24 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $6 | $8 | $9 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $9 | $11 |
| Cardiovascular stress test CPT 93015 • Cardiology | $74 | $98 | $145 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $52 | $52 | $52 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $81 | $107 | $132 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $298 | $320 | $365 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $64 | $143 | $285 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $215 | $229 | $253 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $129 | $276 | $573 |
| Stress echocardiography CPT 93350 • Cardiology | $90 | $246 | $405 |
| Left and right heart catheterization CPT 93452 • Cardiology | $1,000 | $1,075 | $1,151 |
| Left heart catheterization CPT 93458 • Cardiology | $374 | $913 | $1,655 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $424 | $1,241 | $1,873 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $47 | $51 | $56 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $91 | $97 | $104 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $264 | $323 | $433 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $43 | $140 | $294 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $69 | $88 | $110 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $98 | $101 | $104 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $38 | $72 | $102 |