| Allergen specific IgE each allergen CPT 86003 • Allergy | $2 | $4 | $6 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $5 | $32 | $100 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $4 | $6 |
| Allergy testing insect venoms CPT 95017 • Allergy | $4 | $7 | $9 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $8 | $16 | $21 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $5 | $7 | $8 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $8 | $10 | $14 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $9 | $12 | $18 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $4 | $12 | $23 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $40 | $150 | $413 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $40 | $201 | $619 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $40 | $270 | $893 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $40 | $107 | $275 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $40 | $224 | $695 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $40 | $283 | $893 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $40 | $171 | $482 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $40 | $150 | $413 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $40 | $629 | $1,340 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $40 | $261 | $826 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $40 | $150 | $413 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $40 | $261 | $814 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $40 | $315 | $1,065 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $423 | $685 | $795 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $743 | $960 | $1,181 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $269 | $1,553 | $2,344 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $1,776 | $2,252 | $2,519 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $42 | $2,105 | $3,746 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $462 | $527 | $599 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $513 | $586 | $665 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $15 | $19 | $28 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $7 | $10 | $18 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $7 | $9 | $13 |
| Cardiovascular stress test CPT 93015 • Cardiology | $66 | $91 | $113 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $35 | $50 | $68 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $73 | $109 | $169 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $69 | $196 | $404 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $51 | $180 | $231 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $132 | $207 | $289 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $134 | $244 | $328 |
| Stress echocardiography CPT 93350 • Cardiology | $105 | $169 | $212 |
| Left and right heart catheterization CPT 93452 • Cardiology | $285 | $491 | $795 |
| Left heart catheterization CPT 93458 • Cardiology | $351 | $641 | $890 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $395 | $665 | $1,072 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $131 | $195 | $239 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $73 | $92 | $111 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $39 | $163 | $267 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $34 | $141 | $231 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $19 | $52 | $112 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $27 | $58 | $103 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $47 | $81 | $105 |