| Allergen specific IgE each allergen CPT 86003 • Allergy | $4 | $5 | $5 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $6 | $8 | $9 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $7 | $11 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $12 | $24 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $20 | $33 | $39 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $1 | $6 | $13 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $4 | $15 | $27 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $5 | $18 | $32 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $18 | $32 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $40 | $538 | $1,480 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $40 | $436 | $962 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $104 | $569 | $888 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $104 | $351 | $518 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $40 | $448 | $1,036 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $40 | $379 | $1,332 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $40 | $594 | $1,480 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $40 | $474 | $1,110 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $40 | $684 | $1,628 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $104 | $788 | $1,332 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $101 | $799 | $1,924 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $101 | $859 | $1,776 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $40 | $463 | $1,184 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $398 | $1,102 | $1,988 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $110 | $1,807 | $3,504 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $40 | $2,945 | $7,129 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $391 | $4,381 | $8,370 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $496 | $4,903 | $9,311 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $53 | $887 | $1,721 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $439 | $1,136 | $1,918 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $3 | $25 | $40 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $3 | $11 | $17 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $2 | $14 | $23 |
| Cardiovascular stress test CPT 93015 • Cardiology | $14 | $128 | $235 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $34 | $75 | $117 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $145 | $171 | $240 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $55 | $375 | $867 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $168 | $350 | $523 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $132 | $367 | $537 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $211 | $298 | $431 |
| Stress echocardiography CPT 93350 • Cardiology | $39 | $227 | $386 |
| Left and right heart catheterization CPT 93452 • Cardiology | $772 | $1,047 | $1,322 |
| Left heart catheterization CPT 93458 • Cardiology | $541 | $1,400 | $2,471 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $621 | $2,157 | $3,694 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $99 | $175 | $337 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $78 | $144 | $192 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $68 | $326 | $557 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $97 | $284 | $426 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $40 | $110 | $181 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $13 | $111 | $208 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $4 | $140 | $257 |