| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $4 | $7 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $4 | $5 | $7 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $5 | $6 |
| Allergy testing insect venoms CPT 95017 • Allergy | $4 | $8 | $11 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $7 | $17 | $30 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $1 | $6 | $8 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $8 | $11 | $19 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $9 | $13 | $24 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $4 | $11 | $15 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $48 | $390 | $936 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $48 | $298 | $936 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $48 | $298 | $936 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $48 | $208 | $624 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $48 | $343 | $1,092 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $48 | $493 | $1,404 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $48 | $343 | $1,092 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $48 | $339 | $936 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $48 | $348 | $981 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $48 | $442 | $1,248 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $48 | $339 | $936 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $48 | $450 | $1,248 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $48 | $441 | $1,121 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $529 | $730 | $1,183 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $528 | $1,094 | $2,008 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $1,719 | $2,415 | $4,150 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,253 | $2,990 | $4,874 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $359 | $2,350 | $3,687 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $482 | $679 | $1,158 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $580 | $762 | $1,285 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $13 | $24 | $37 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $6 | $11 | $21 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $7 | $11 | $17 |
| Cardiovascular stress test CPT 93015 • Cardiology | $67 | $106 | $157 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $33 | $46 | $81 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $73 | $124 | $200 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $69 | $154 | $262 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $140 | $241 | $468 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $63 | $183 | $419 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $97 | $218 | $499 |
| Stress echocardiography CPT 93350 • Cardiology | $68 | $151 | $394 |
| Left and right heart catheterization CPT 93452 • Cardiology | $609 | $674 | $795 |
| Left heart catheterization CPT 93458 • Cardiology | $312 | $1,048 | $2,197 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $304 | $1,142 | $2,365 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $38 | $211 | $412 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $12 | $102 | $181 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $29 | $237 | $520 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $33 | $158 | $406 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $20 | $41 | $49 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $53 | $61 | $79 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $57 | $98 | $145 |