| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $5 | $8 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $4 | $7 | $12 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $4 | $4 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $6 | $8 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $5 | $9 | $15 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $1 | $5 | $7 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $7 | $9 | $12 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $9 | $12 | $14 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $9 | $15 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $3 | $397 | $649 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $3 | $385 | $611 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $3 | $397 | $649 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $3 | $257 | $407 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $3 | $463 | $757 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $3 | $475 | $810 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $3 | $369 | $630 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $3 | $325 | $540 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $3 | $692 | $1,098 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $3 | $513 | $815 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $3 | $385 | $611 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $3 | $670 | $1,286 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $3 | $555 | $1,121 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $463 | $484 | $507 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $130 | $769 | $1,325 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $1,959 | $2,233 | $2,508 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $275 | $1,674 | $2,446 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $1,513 | $2,360 | $3,014 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $468 | $498 | $516 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $521 | $537 | $568 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $11 | $15 | $22 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $5 | $7 | $9 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $6 | $9 | $12 |
| Cardiovascular stress test CPT 93015 • Cardiology | $66 | $97 | $137 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $34 | $39 | $46 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $66 | $113 | $203 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $235 | $263 | $277 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $57 | $170 | $232 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $132 | $202 | $297 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $42 | $132 | $233 |
| Stress echocardiography CPT 93350 • Cardiology | $67 | $129 | $197 |
| Left and right heart catheterization CPT 93452 • Cardiology | $886 | $919 | $943 |
| Left heart catheterization CPT 93458 • Cardiology | $673 | $930 | $1,075 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $295 | $766 | $1,170 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $36 | $137 | $223 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $11 | $32 | $75 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $204 | $223 | $242 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $32 | $168 | $283 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $12 | $29 | $59 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $14 | $37 | $80 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $37 | $113 | $151 |