| Allergen specific IgE each allergen CPT 86003 • Allergy | $1 | $4 | $7 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $3 | $4 | $4 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $4 | $5 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $4 | $7 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $7 | $15 | $20 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $8 | $11 | $19 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $9 | $10 | $12 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $6 | $14 | $25 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $15 | $20 | $31 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $40 | $156 | $496 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $44 | $166 | $521 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $44 | $165 | $520 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $44 | $138 | $408 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $44 | $143 | $425 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $44 | $389 | $1,416 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $44 | $164 | $510 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $44 | $104 | $278 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $44 | $182 | $578 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $40 | $218 | $743 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $44 | $186 | $595 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $44 | $163 | $510 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $44 | $219 | $730 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $125 | $295 | $464 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,100 | $2,445 | $4,991 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $413 | $1,242 | $1,776 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $258 | $4,288 | $12,121 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $287 | $1,828 | $2,868 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $99 | $258 | $417 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $412 | $597 | $817 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $14 | $18 | $22 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $3 | $9 | $14 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $14 | $21 |
| Cardiovascular stress test CPT 93015 • Cardiology | $14 | $55 | $96 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $37 | $39 | $43 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $78 | $88 | $98 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $139 | $337 | $535 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $44 | $61 | $89 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $130 | $171 | $211 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $49 | $103 | $158 |
| Stress echocardiography CPT 93350 • Cardiology | $90 | $147 | $196 |
| Left and right heart catheterization CPT 93452 • Cardiology | $969 | $1,871 | $2,772 |
| Left heart catheterization CPT 93458 • Cardiology | $403 | $709 | $1,111 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $318 | $559 | $895 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $38 | $126 | $265 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $17 | $64 | $113 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $219 | $348 | $494 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $61 | $158 | $314 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $10 | $31 | $68 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $44 | $82 | $120 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $48 | $97 | $134 |