| Allergen specific IgE each allergen CPT 86003 • Allergy | $4 | $6 | $9 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $5 | $6 | $7 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $5 | $8 |
| Allergy testing insect venoms CPT 95017 • Allergy | $7 | $9 | $12 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $18 | $23 | $28 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $10 | $10 | $10 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $20 | $20 | $20 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $11 | $14 | $16 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $8 | $12 | $17 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $62 | $217 | $371 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $75 | $289 | $420 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $30 | $75 | $120 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $62 | $155 | $247 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $62 | $309 | $433 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $30 | $235 | $556 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $30 | $53 | $75 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $30 | $190 | $420 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $62 | $392 | $556 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $30 | $194 | $494 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $57 | $266 | $371 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $62 | $278 | $494 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $75 | $272 | $371 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $507 | $633 | $724 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $30 | $1,056 | $2,083 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $30 | $1,499 | $2,650 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,029 | $2,492 | $3,111 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $3,468 | $3,468 | $3,468 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $1,060 | $1,133 | $1,205 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $935 | $1,248 | $1,561 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $22 | $28 | $38 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $9 | $11 | $12 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $11 | $15 | $19 |
| Cardiovascular stress test CPT 93015 • Cardiology | $69 | $108 | $160 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $55 | $64 | $73 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $95 | $146 | $198 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $34 | $72 | $119 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $376 | $376 | $376 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $308 | $314 | $319 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $42 | $197 | $387 |
| Stress echocardiography CPT 93350 • Cardiology | $191 | $266 | $303 |
| Left and right heart catheterization CPT 93452 • Cardiology | $1,502 | $1,502 | $1,502 |
| Left heart catheterization CPT 93458 • Cardiology | $489 | $739 | $990 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $1,120 | $1,443 | $1,764 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $37 | $277 | $517 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $99 | $104 | $108 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $50 | $281 | $477 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $225 | $296 | $357 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $42 | $96 | $141 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $19 | $93 | $166 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $49 | $49 | $49 |