| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $5 | $7 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $4 | $7 | $11 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $6 | $9 |
| Allergy testing insect venoms CPT 95017 • Allergy | $8 | $14 | $21 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $24 | $31 | $52 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $1 | $9 | $13 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $12 | $19 | $31 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $15 | $24 | $41 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $17 | $24 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $30 | $190 | $611 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $30 | $122 | $407 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $27 | $192 | $611 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $41 | $111 | $272 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $30 | $181 | $713 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $41 | $226 | $917 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $27 | $158 | $475 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $30 | $163 | $611 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $27 | $162 | $611 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $30 | $203 | $815 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $41 | $165 | $611 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $41 | $257 | $857 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $41 | $379 | $1,682 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $30 | $650 | $1,120 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,051 | $1,352 | $1,950 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $30 | $1,819 | $4,103 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,542 | $3,014 | $4,416 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,824 | $3,371 | $4,669 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $504 | $724 | $1,279 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $604 | $826 | $1,421 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $17 | $29 | $57 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $7 | $16 | $37 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $9 | $13 | $20 |
| Cardiovascular stress test CPT 93015 • Cardiology | $85 | $124 | $230 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $33 | $69 | $141 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $85 | $159 | $348 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $305 | $372 | $396 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $259 | $338 | $474 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $79 | $199 | $275 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $277 | $319 | $333 |
| Stress echocardiography CPT 93350 • Cardiology | $30 | $167 | $259 |
| Left and right heart catheterization CPT 93452 • Cardiology | $582 | $1,143 | $1,994 |
| Left heart catheterization CPT 93458 • Cardiology | $338 | $1,152 | $2,481 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $918 | $1,641 | $2,741 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $224 | $311 | $407 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $97 | $129 | $184 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $68 | $262 | $335 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $220 | $288 | $352 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $41 | $89 | $126 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $26 | $85 | $114 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $36 | $143 | $225 |