| Allergen specific IgE each allergen CPT 86003 • Allergy | $2 | $5 | $7 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $4 | $7 | $11 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $6 | $15 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $9 | $18 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $5 | $29 | $47 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $1 | $9 | $18 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $6 | $8 | $11 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $7 | $17 | $26 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $9 | $19 | $30 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $49 | $206 | $362 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $49 | $351 | $606 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $30 | $107 | $243 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $49 | $153 | $241 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $49 | $361 | $609 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $30 | $313 | $783 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $30 | $140 | $340 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $30 | $244 | $606 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $30 | $319 | $783 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $30 | $315 | $696 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $49 | $336 | $522 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $49 | $404 | $679 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $49 | $852 | $2,474 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $431 | $812 | $1,264 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $757 | $933 | $1,146 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $317 | $1,735 | $3,238 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $1,842 | $4,127 | $5,316 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,056 | $2,056 | $2,056 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $446 | $446 | $446 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $496 | $619 | $742 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $11 | $25 | $42 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $5 | $14 | $27 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $6 | $10 | $15 |
| Cardiovascular stress test CPT 93015 • Cardiology | $53 | $115 | $175 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $24 | $24 | $24 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $64 | $124 | $184 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $128 | $153 | $177 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $81 | $135 | $169 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $58 | $214 | $491 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $95 | $351 | $596 |
| Stress echocardiography CPT 93350 • Cardiology | $57 | $255 | $467 |
| Left and right heart catheterization CPT 93452 • Cardiology | $669 | $672 | $675 |
| Left heart catheterization CPT 93458 • Cardiology | $374 | $581 | $788 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $424 | $1,430 | $2,845 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $28 | $43 | $52 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $44 | $112 | $203 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $28 | $352 | $594 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $24 | $223 | $452 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $46 | $74 | $110 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $30 | $42 | $55 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $50 | $101 | $180 |