| Allergen specific IgE each allergen CPT 86003 • Allergy | $1 | $2 | $4 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $2 | $5 | $9 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $6 | $7 | $8 |
| Allergy testing insect venoms CPT 95017 • Allergy | $4 | $6 | $9 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $22 | $24 | $27 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $7 | $8 | $9 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $1 | $8 | $12 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $2 | $9 | $15 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $13 | $14 | $16 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $32 | $46 | $73 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $32 | $46 | $73 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $32 | $46 | $73 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $32 | $46 | $73 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $32 | $46 | $73 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $32 | $46 | $73 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $32 | $46 | $73 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $32 | $46 | $73 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $32 | $46 | $73 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $32 | $46 | $73 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $32 | $46 | $73 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $32 | $46 | $73 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $32 | $46 | $73 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $443 | $646 | $905 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $102 | $898 | $1,567 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $209 | $1,712 | $3,215 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $367 | $2,196 | $3,772 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $1,363 | $2,782 | $4,200 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $82 | $372 | $662 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $91 | $413 | $735 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $10 | $18 | $24 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $11 | $12 | $13 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $4 | $8 | $11 |
| Cardiovascular stress test CPT 93015 • Cardiology | $19 | $77 | $115 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $57 | $62 | $67 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $55 | $98 | $130 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $16 | $100 | $206 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $67 | $183 | $262 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $85 | $168 | $243 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $253 | $285 | $337 |
| Stress echocardiography CPT 93350 • Cardiology | $33 | $171 | $262 |
| Left and right heart catheterization CPT 93452 • Cardiology | $317 | $615 | $873 |
| Left heart catheterization CPT 93458 • Cardiology | $311 | $795 | $1,299 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $351 | $995 | $1,435 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $30 | $34 | $38 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $58 | $98 | $121 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $36 | $107 | $190 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $196 | $258 | $320 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $34 | $56 | $89 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $5 | $84 | $150 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $48 | $133 | $194 |