| Allergen specific IgE each allergen CPT 86003 • Allergy | $2 | $4 | $6 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $1 | $4 | $6 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $5 | $7 | $9 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $9 | $20 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $8 | $25 | $44 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $6 | $12 | $18 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $18 | $20 | $22 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $12 | $19 | $26 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $9 | $17 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $38 | $51 | $60 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $55 | $238 | $330 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $38 | $202 | $513 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $38 | $43 | $50 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $41 | $230 | $598 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $38 | $45 | $50 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $41 | $44 | $50 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $38 | $51 | $60 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $30 | $193 | $495 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $23 | $40 | $55 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $30 | $40 | $50 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $30 | $42 | $55 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $30 | $42 | $55 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $358 | $907 | $1,486 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $44 | $915 | $2,617 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,315 | $3,855 | $5,394 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $1,002 | $3,464 | $6,332 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $432 | $3,737 | $7,042 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $157 | $770 | $1,550 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $694 | $1,099 | $1,730 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $5 | $14 | $18 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $8 | $8 | $9 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $9 | $10 | $10 |
| Cardiovascular stress test CPT 93015 • Cardiology | $90 | $133 | $195 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $12 | $58 | $99 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $114 | $146 | $201 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $41 | $291 | $724 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $407 | $424 | $441 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $100 | $235 | $355 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $190 | $285 | $362 |
| Stress echocardiography CPT 93350 • Cardiology | $143 | $189 | $237 |
| Left and right heart catheterization CPT 93452 • Cardiology | $258 | $1,039 | $2,525 |
| Left heart catheterization CPT 93458 • Cardiology | $366 | $1,218 | $2,069 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $472 | $1,689 | $3,145 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $47 | $145 | $215 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $61 | $89 | $107 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $45 | $135 | $311 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $188 | $207 | $226 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $66 | $124 | $182 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $3 | $106 | $209 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $36 | $147 | $259 |