| Allergen specific IgE each allergen CPT 86003 • Allergy | $2 | $4 | $6 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $5 | $17 | $34 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $4 | $4 |
| Allergy testing insect venoms CPT 95017 • Allergy | $4 | $6 | $11 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $5 | $12 | $26 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $1 | $6 | $10 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $11 | $14 | $20 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $11 | $14 | $18 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $10 | $17 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $40 | $512 | $1,016 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $40 | $308 | $480 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $40 | $512 | $1,016 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $40 | $270 | $452 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $40 | $595 | $1,185 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $40 | $456 | $720 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $40 | $333 | $560 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $40 | $249 | $480 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $40 | $511 | $981 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $40 | $379 | $640 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $40 | $287 | $480 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $40 | $528 | $903 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $40 | $399 | $677 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $483 | $7,891 | $43,834 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $605 | $23,342 | $111,804 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $1,959 | $2,845 | $3,828 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $1,505 | $2,941 | $4,048 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $1,032 | $2,873 | $3,845 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $510 | $4,496 | $22,265 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $619 | $5,082 | $22,265 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $14 | $21 | $28 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $11 | $18 | $30 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $14 | $25 |
| Cardiovascular stress test CPT 93015 • Cardiology | $76 | $101 | $123 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $46 | $69 | $119 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $95 | $133 | $169 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $88 | $236 | $306 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $231 | $421 | $756 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $289 | $408 | $674 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $109 | $297 | $417 |
| Stress echocardiography CPT 93350 • Cardiology | $184 | $378 | $616 |
| Left and right heart catheterization CPT 93452 • Cardiology | $310 | $4,112 | $18,765 |
| Left heart catheterization CPT 93458 • Cardiology | $381 | $4,574 | $18,765 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $429 | $4,390 | $18,765 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $156 | $230 | $322 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $75 | $105 | $141 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $41 | $253 | $411 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $31 | $272 | $519 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $19 | $218 | $896 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $17 | $212 | $896 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $37 | $227 | $896 |