| Allergen specific IgE each allergen CPT 86003 • Allergy | $1 | $3 | $5 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $0 | $3 | $8 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $5 | $7 | $11 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $10 | $24 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $24 | $35 | $56 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $3 | $7 | $12 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $1 | $14 | $27 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $12 | $20 | $32 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $23 | $29 | $42 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $33 | $58 | $108 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $34 | $58 | $108 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $33 | $58 | $108 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $33 | $58 | $108 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $33 | $58 | $108 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $33 | $55 | $98 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $33 | $58 | $108 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $33 | $58 | $108 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $33 | $58 | $108 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $33 | $58 | $108 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $33 | $58 | $108 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $33 | $58 | $108 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $33 | $58 | $108 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $115 | $936 | $2,121 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,994 | $2,867 | $3,739 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $48 | $2,292 | $4,813 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $1,748 | $4,336 | $8,931 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $1,937 | $5,936 | $9,935 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $287 | $1,084 | $1,880 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $478 | $1,227 | $2,096 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $22 | $31 | $46 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $7 | $13 | $20 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $9 | $15 | $26 |
| Cardiovascular stress test CPT 93015 • Cardiology | $22 | $129 | $257 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $68 | $97 | $127 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $132 | $176 | $262 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $17 | $350 | $947 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $34 | $303 | $572 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $222 | $326 | $459 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $357 | $408 | $470 |
| Stress echocardiography CPT 93350 • Cardiology | $47 | $233 | $421 |
| Left and right heart catheterization CPT 93452 • Cardiology | $843 | $896 | $923 |
| Left heart catheterization CPT 93458 • Cardiology | $1,149 | $2,231 | $3,750 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $1,191 | $1,414 | $1,784 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $124 | $200 | $272 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $29 | $130 | $220 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $121 | $183 | $215 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $221 | $364 | $596 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $4 | $116 | $227 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $7 | $39 | $71 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $17 | $57 | $121 |