| Allergen specific IgE each allergen CPT 86003 • Allergy | $1 | $4 | $7 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $2 | $6 | $11 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $5 | $6 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $3 | $4 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $7 | $17 | $23 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $1 | $7 | $12 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $9 | $12 | $13 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $11 | $12 | $14 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $12 | $28 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $62 | $323 | $496 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $62 | $327 | $521 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $62 | $329 | $520 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $62 | $199 | $247 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $62 | $315 | $433 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $62 | $648 | $1,416 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $62 | $342 | $460 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $62 | $248 | $371 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $44 | $341 | $700 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $62 | $402 | $555 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $62 | $348 | $587 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $62 | $313 | $494 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $62 | $381 | $730 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $669 | $698 | $756 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $896 | $1,157 | $1,313 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $30 | $1,049 | $2,653 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $258 | $2,326 | $5,316 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $30 | $1,747 | $3,464 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $99 | $728 | $1,308 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $110 | $581 | $863 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $15 | $20 | $27 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $6 | $11 | $15 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $4 | $10 | $13 |
| Cardiovascular stress test CPT 93015 • Cardiology | $69 | $103 | $128 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $7 | $40 | $72 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $72 | $101 | $146 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $70 | $147 | $224 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $44 | $123 | $187 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $193 | $269 | $329 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $124 | $211 | $313 |
| Stress echocardiography CPT 93350 • Cardiology | $30 | $149 | $282 |
| Left and right heart catheterization CPT 93452 • Cardiology | $372 | $671 | $969 |
| Left heart catheterization CPT 93458 • Cardiology | $380 | $778 | $1,532 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $465 | $995 | $1,445 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $38 | $128 | $265 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $18 | $88 | $160 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $198 | $302 | $366 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $35 | $58 | $99 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $29 | $51 | $94 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $74 | $92 | $122 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $96 | $122 | $139 |