| Allergen specific IgE each allergen CPT 86003 • Allergy | $1 | $3 | $5 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $6 | $7 | $8 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $6 | $11 |
| Allergy testing insect venoms CPT 95017 • Allergy | $6 | $8 | $11 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $15 | $30 | $58 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $1 | $10 | $23 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $1 | $15 | $29 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $1 | $17 | $33 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $2 | $8 | $12 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $45 | $292 | $732 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $45 | $295 | $732 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $109 | $524 | $732 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $45 | $214 | $488 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $45 | $336 | $854 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $109 | $768 | $1,098 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $98 | $602 | $854 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $109 | $524 | $732 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $109 | $768 | $1,098 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $109 | $687 | $976 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $45 | $63 | $98 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $45 | $377 | $976 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $45 | $295 | $732 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $583 | $1,127 | $2,214 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $514 | $2,208 | $3,902 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $1,458 | $3,136 | $4,813 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,446 | $4,738 | $9,321 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,721 | $6,544 | $10,368 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $234 | $1,098 | $1,962 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $521 | $1,354 | $2,187 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $15 | $26 | $48 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $3 | $10 | $21 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $2 | $12 | $28 |
| Cardiovascular stress test CPT 93015 • Cardiology | $38 | $127 | $268 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $37 | $85 | $133 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $76 | $142 | $274 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $138 | $467 | $988 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $166 | $381 | $596 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $74 | $182 | $264 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $189 | $447 | $901 |
| Stress echocardiography CPT 93350 • Cardiology | $197 | $366 | $704 |
| Left and right heart catheterization CPT 93452 • Cardiology | $880 | $912 | $943 |
| Left heart catheterization CPT 93458 • Cardiology | $816 | $956 | $1,096 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $340 | $918 | $1,243 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $140 | $386 | $631 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $38 | $127 | $270 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $35 | $127 | $220 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $31 | $77 | $112 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $1 | $119 | $237 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $14 | $144 | $274 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $32 | $185 | $338 |