| Allergen specific IgE each allergen CPT 86003 • Allergy | $1 | $7 | $13 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $1 | $10 | $20 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $5 | $7 |
| Allergy testing insect venoms CPT 95017 • Allergy | $4 | $8 | $12 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $20 | $25 | $31 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $1 | $5 | $8 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $2 | $9 | $15 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $10 | $14 | $19 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $10 | $12 | $14 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $30 | $69 | $108 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $30 | $69 | $108 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $30 | $65 | $100 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $44 | $72 | $100 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $30 | $69 | $108 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $30 | $69 | $108 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $30 | $69 | $108 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $40 | $74 | $108 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $40 | $74 | $108 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $40 | $70 | $100 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $30 | $69 | $108 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $44 | $76 | $108 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $30 | $69 | $108 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $30 | $443 | $856 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,100 | $1,292 | $1,484 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $1,273 | $2,166 | $3,060 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $44 | $1,788 | $3,531 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $238 | $2,065 | $3,891 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $77 | $535 | $993 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $57 | $580 | $1,103 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $7 | $22 | $37 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $1 | $12 | $23 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $4 | $9 | $14 |
| Cardiovascular stress test CPT 93015 • Cardiology | $15 | $92 | $169 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $17 | $60 | $104 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $72 | $148 | $223 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $89 | $184 | $280 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $44 | $76 | $108 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $125 | $290 | $456 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $187 | $211 | $235 |
| Stress echocardiography CPT 93350 • Cardiology | $184 | $188 | $193 |
| Left and right heart catheterization CPT 93452 • Cardiology | $475 | $690 | $906 |
| Left heart catheterization CPT 93458 • Cardiology | $1,041 | $1,478 | $1,914 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $658 | $749 | $840 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $49 | $87 | $124 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $12 | $95 | $179 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $118 | $312 | $506 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $183 | $270 | $356 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $13 | $41 | $69 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $30 | $58 | $86 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $13 | $93 | $174 |