| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $6 | $12 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $6 | $12 | $18 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $5 | $9 |
| Allergy testing insect venoms CPT 95017 • Allergy | $8 | $12 | $21 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $18 | $29 | $48 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $7 | $13 | $19 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $25 | $25 | $25 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $10 | $17 | $30 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $25 | $30 | $36 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $30 | $73 | $116 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $116 | $309 | $424 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $116 | $480 | $900 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $30 | $56 | $81 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $30 | $344 | $1,200 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $30 | $157 | $324 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $43 | $541 | $1,500 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $30 | $317 | $700 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $30 | $472 | $1,700 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $30 | $447 | $1,600 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $30 | $47 | $81 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $30 | $549 | $1,500 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $30 | $644 | $2,400 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $457 | $796 | $1,424 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $2,508 | $2,508 | $2,508 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $1,818 | $2,913 | $5,102 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $1,908 | $3,937 | $5,989 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $6,650 | $6,650 | $6,650 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $984 | $1,079 | $1,174 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $1,307 | $1,307 | $1,307 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $13 | $23 | $34 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $5 | $10 | $15 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $13 | $19 |
| Cardiovascular stress test CPT 93015 • Cardiology | $68 | $103 | $172 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $33 | $53 | $92 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $72 | $123 | $174 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $177 | $352 | $632 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $126 | $328 | $531 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $183 | $250 | $317 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $234 | $478 | $637 |
| Stress echocardiography CPT 93350 • Cardiology | $156 | $174 | $184 |
| Left and right heart catheterization CPT 93452 • Cardiology | $675 | $1,404 | $2,133 |
| Left heart catheterization CPT 93458 • Cardiology | $754 | $1,285 | $1,816 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $1,029 | $1,601 | $2,655 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $86 | $86 | $86 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $79 | $126 | $173 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $222 | $347 | $585 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $183 | $281 | $380 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $84 | $147 | $210 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $21 | $41 | $61 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $36 | $166 | $295 |