| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $6 | $11 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $5 | $8 | $11 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $8 | $20 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $10 | $21 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $6 | $26 | $57 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $1 | $10 | $21 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $12 | $14 | $18 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $14 | $16 | $20 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $18 | $36 |
| Sublingual allergen immunotherapy CPT 95199 • Allergy | $0 | $0 | $0 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $3 | $184 | $434 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $3 | $317 | $651 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $3 | $274 | $497 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $3 | $159 | $434 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $3 | $368 | $760 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $3 | $404 | $745 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $3 | $211 | $507 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $3 | $274 | $497 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $3 | $261 | $651 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $3 | $418 | $869 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $3 | $274 | $497 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $3 | $696 | $2,258 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $3 | $599 | $2,062 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $45 | $596 | $987 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $729 | $1,191 | $1,651 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,018 | $2,895 | $3,592 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $394 | $2,750 | $4,494 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $45 | $2,066 | $3,641 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $526 | $728 | $936 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $585 | $809 | $1,040 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $15 | $19 | $21 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $7 | $11 | $23 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $11 | $14 |
| Cardiovascular stress test CPT 93015 • Cardiology | $90 | $104 | $124 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $45 | $54 | $68 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $74 | $100 | $118 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $169 | $322 | $442 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $59 | $212 | $361 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $89 | $200 | $327 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $201 | $299 | $395 |
| Stress echocardiography CPT 93350 • Cardiology | $141 | $198 | $308 |
| Left and right heart catheterization CPT 93452 • Cardiology | $782 | $1,196 | $2,269 |
| Left heart catheterization CPT 93458 • Cardiology | $815 | $1,498 | $3,264 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $331 | $1,112 | $1,806 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $51 | $221 | $313 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $79 | $103 | $136 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $36 | $276 | $393 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $43 | $204 | $307 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $13 | $80 | $117 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $17 | $82 | $124 |