| Allergen specific IgE each allergen CPT 86003 • Allergy | $2 | $4 | $8 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $5 | $8 | $14 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $4 | $7 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $6 | $18 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $6 | $16 | $27 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $1 | $5 | $11 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $6 | $14 | $19 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $7 | $20 | $26 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $2 | $8 | $14 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $40 | $241 | $446 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $40 | $234 | $446 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $40 | $200 | $446 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $40 | $168 | $298 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $40 | $278 | $521 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $40 | $280 | $670 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $40 | $236 | $521 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $40 | $204 | $446 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $40 | $348 | $670 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $40 | $312 | $595 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $40 | $234 | $446 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $40 | $315 | $595 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $40 | $413 | $1,030 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $328 | $700 | $1,060 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $576 | $1,322 | $1,991 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $1,173 | $2,110 | $2,920 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $1,379 | $2,614 | $4,758 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $1,538 | $2,942 | $4,783 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $334 | $767 | $1,420 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $371 | $921 | $1,577 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $6 | $13 | $25 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $5 | $18 | $41 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $5 | $15 | $25 |
| Cardiovascular stress test CPT 93015 • Cardiology | $43 | $111 | $200 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $21 | $55 | $77 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $32 | $83 | $154 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $48 | $174 | $425 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $39 | $187 | $281 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $82 | $196 | $309 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $33 | $214 | $339 |
| Stress echocardiography CPT 93350 • Cardiology | $66 | $134 | $186 |
| Left and right heart catheterization CPT 93452 • Cardiology | $148 | $420 | $917 |
| Left heart catheterization CPT 93458 • Cardiology | $308 | $592 | $1,029 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $210 | $738 | $1,328 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $47 | $170 | $250 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $11 | $84 | $200 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $24 | $195 | $529 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $21 | $162 | $246 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $10 | $43 | $66 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $45 | $59 | $85 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $47 | $78 | $114 |