| Allergen specific IgE each allergen CPT 86003 • Allergy | $1 | $4 | $7 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $1 | $6 | $11 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $5 | $8 | $15 |
| Allergy testing insect venoms CPT 95017 • Allergy | $2 | $9 | $20 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $6 | $23 | $49 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $6 | $10 | $19 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $1 | $11 | $21 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $2 | $13 | $25 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $2 | $17 | $31 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $45 | $195 | $496 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $45 | $113 | $248 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $45 | $192 | $486 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $45 | $172 | $425 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $45 | $172 | $425 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $45 | $325 | $885 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $45 | $130 | $300 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $45 | $313 | $850 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $45 | $250 | $659 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $45 | $268 | $714 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $45 | $234 | $612 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $45 | $200 | $510 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $45 | $273 | $730 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $45 | $1,459 | $2,874 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $85 | $1,792 | $4,991 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $45 | $4,311 | $10,308 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $1,024 | $5,672 | $12,121 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $458 | $6,986 | $13,514 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $71 | $926 | $1,782 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $52 | $949 | $1,978 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $7 | $21 | $41 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $6 | $12 | $19 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $6 | $12 | $21 |
| Cardiovascular stress test CPT 93015 • Cardiology | $30 | $113 | $242 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $31 | $57 | $121 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $36 | $132 | $289 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $60 | $219 | $535 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $89 | $131 | $211 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $51 | $271 | $723 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $19 | $399 | $1,053 |
| Stress echocardiography CPT 93350 • Cardiology | $45 | $215 | $528 |
| Left and right heart catheterization CPT 93452 • Cardiology | $499 | $1,215 | $1,932 |
| Left heart catheterization CPT 93458 • Cardiology | $403 | $1,449 | $3,389 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $465 | $1,629 | $3,744 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $80 | $269 | $461 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $14 | $103 | $214 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $32 | $167 | $330 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $28 | $142 | $364 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $6 | $57 | $126 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $15 | $39 | $63 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $13 | $84 | $132 |