| Allergen specific IgE each allergen CPT 86003 • Allergy | $1 | $4 | $7 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $1 | $6 | $11 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $5 | $8 | $15 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $6 | $10 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $6 | $24 | $49 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $1 | $9 | $19 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $8 | $14 | $21 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $1 | $12 | $25 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $8 | $14 | $25 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $42 | $195 | $500 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $42 | $202 | $521 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $42 | $132 | $312 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $42 | $99 | $212 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $42 | $170 | $425 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $42 | $323 | $885 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $42 | $170 | $425 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $42 | $161 | $400 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $42 | $229 | $602 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $42 | $276 | $743 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $42 | $224 | $587 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $42 | $202 | $521 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $42 | $271 | $730 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $446 | $1,305 | $2,874 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $207 | $2,147 | $4,991 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $42 | $2,743 | $10,308 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,460 | $5,228 | $12,121 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $42 | $4,656 | $13,514 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $510 | $934 | $1,782 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $113 | $970 | $1,978 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $8 | $21 | $41 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $2 | $11 | $19 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $4 | $11 | $21 |
| Cardiovascular stress test CPT 93015 • Cardiology | $66 | $118 | $242 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $35 | $67 | $121 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $80 | $150 | $289 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $35 | $213 | $535 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $42 | $277 | $543 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $54 | $217 | $512 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $54 | $383 | $1,053 |
| Stress echocardiography CPT 93350 • Cardiology | $156 | $336 | $764 |
| Left and right heart catheterization CPT 93452 • Cardiology | $231 | $545 | $841 |
| Left heart catheterization CPT 93458 • Cardiology | $403 | $1,031 | $2,356 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $324 | $1,110 | $2,580 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $86 | $245 | $385 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $30 | $66 | $113 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $101 | $184 | $330 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $30 | $170 | $453 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $42 | $70 | $126 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $9 | $69 | $154 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $26 | $127 | $263 |