| Allergen specific IgE each allergen CPT 86003 • Allergy | $1 | $2 | $3 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $3 | $4 | $5 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $5 | $7 |
| Allergy testing insect venoms CPT 95017 • Allergy | $6 | $6 | $7 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $6 | $12 | $18 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $1 | $6 | $11 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $1 | $7 | $12 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $2 | $9 | $14 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $11 | $15 | $19 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $42 | $193 | $496 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $30 | $111 | $272 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $42 | $201 | $520 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $42 | $178 | $451 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $30 | $231 | $620 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $30 | $189 | $496 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $30 | $194 | $510 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $30 | $109 | $267 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $30 | $244 | $659 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $30 | $205 | $555 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $42 | $226 | $595 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $30 | $198 | $521 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $30 | $267 | $730 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $416 | $505 | $594 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $134 | $689 | $1,243 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $42 | $1,311 | $2,580 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $30 | $1,037 | $2,460 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $238 | $238 | $238 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $77 | $77 | $77 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $430 | $616 | $803 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $14 | $17 | $22 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $3 | $8 | $14 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $7 | $9 | $12 |
| Cardiovascular stress test CPT 93015 • Cardiology | $14 | $66 | $120 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $7 | $25 | $43 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $36 | $58 | $80 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $69 | $79 | $89 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $61 | $194 | $311 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $69 | $183 | $278 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $27 | $140 | $268 |
| Stress echocardiography CPT 93350 • Cardiology | $37 | $135 | $212 |
| Left and right heart catheterization CPT 93452 • Cardiology | $675 | $735 | $796 |
| Left heart catheterization CPT 93458 • Cardiology | $287 | $457 | $682 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $465 | $886 | $1,120 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $171 | $207 | $265 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $12 | $68 | $110 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $169 | $232 | $330 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $30 | $80 | $150 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $1 | $22 | $42 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $60 | $60 | $60 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $36 | $46 | $53 |