| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $4 | $6 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $4 | $6 | $8 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $4 | $4 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $4 | $8 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $5 | $15 | $19 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $1 | $4 | $8 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $8 | $10 | $14 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $10 | $13 | $18 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $9 | $14 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $3 | $144 | $473 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $3 | $183 | $709 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $3 | $183 | $709 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $3 | $97 | $272 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $3 | $151 | $475 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $3 | $238 | $917 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $3 | $164 | $551 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $3 | $144 | $473 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $3 | $203 | $709 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $3 | $236 | $945 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $3 | $144 | $473 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $3 | $222 | $857 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $3 | $390 | $1,950 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $483 | $599 | $731 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $134 | $849 | $1,181 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $1,719 | $1,997 | $2,344 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,135 | $2,468 | $3,028 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $359 | $2,214 | $2,902 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $482 | $549 | $624 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $536 | $610 | $693 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $13 | $18 | $28 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $5 | $10 | $18 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $7 | $9 | $11 |
| Cardiovascular stress test CPT 93015 • Cardiology | $67 | $87 | $112 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $33 | $48 | $68 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $67 | $101 | $169 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $88 | $195 | $277 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $57 | $164 | $262 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $63 | $198 | $289 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $97 | $192 | $328 |
| Stress echocardiography CPT 93350 • Cardiology | $121 | $177 | $220 |
| Left and right heart catheterization CPT 93452 • Cardiology | $285 | $713 | $1,104 |
| Left heart catheterization CPT 93458 • Cardiology | $351 | $938 | $1,268 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $395 | $962 | $1,363 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $35 | $181 | $259 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $13 | $71 | $103 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $190 | $248 | $318 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $31 | $181 | $259 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $9 | $24 | $67 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $17 | $62 | $116 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $37 | $80 | $109 |