| Allergen specific IgE each allergen CPT 86003 • Allergy | $1 | $6 | $10 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $3 | $5 | $7 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $4 | $6 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $4 | $6 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $7 | $16 | $23 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $8 | $10 | $12 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $7 | $10 | $12 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $7 | $14 | $24 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $14 | $17 | $25 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $30 | $151 | $496 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $30 | $99 | $272 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $40 | $158 | $486 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $30 | $87 | $238 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $30 | $185 | $620 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $30 | $258 | $885 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $40 | $112 | $300 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $40 | $249 | $850 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $30 | $180 | $578 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $40 | $175 | $555 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $30 | $181 | $587 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $30 | $155 | $510 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $30 | $213 | $730 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $30 | $181 | $464 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $817 | $1,064 | $1,243 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $1,326 | $2,134 | $2,580 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $30 | $985 | $1,953 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $234 | $1,204 | $2,174 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $288 | $408 | $528 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $266 | $891 | $1,606 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $5 | $15 | $23 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $1 | $11 | $19 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $10 | $12 |
| Cardiovascular stress test CPT 93015 • Cardiology | $36 | $65 | $96 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $19 | $31 | $44 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $98 | $107 | $125 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $69 | $76 | $80 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $89 | $140 | $226 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $102 | $190 | $229 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $30 | $85 | $158 |
| Stress echocardiography CPT 93350 • Cardiology | $30 | $67 | $102 |
| Left and right heart catheterization CPT 93452 • Cardiology | $340 | $819 | $1,299 |
| Left heart catheterization CPT 93458 • Cardiology | $293 | $496 | $864 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $299 | $628 | $1,119 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $36 | $100 | $265 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $13 | $67 | $110 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $35 | $169 | $330 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $61 | $136 | $169 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $2 | $35 | $67 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $25 | $34 | $40 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $29 | $71 | $132 |