| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $6 | $13 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $5 | $7 | $9 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $8 | $12 |
| Allergy testing insect venoms CPT 95017 • Allergy | $9 | $16 | $25 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $6 | $36 | $58 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $8 | $15 | $24 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $15 | $20 | $27 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $13 | $25 | $35 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $13 | $26 | $44 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $57 | $263 | $649 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $64 | $264 | $619 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $64 | $262 | $611 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $64 | $159 | $272 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $64 | $305 | $695 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $57 | $289 | $611 |
| Anesthesia for upper GI endoscopy CPT 00740 • Anesthesia | $282 | $282 | $282 |
| Anesthesia for lower GI endoscopy CPT 00810 • Anesthesia | $282 | $282 | $282 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $64 | $309 | $713 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $64 | $212 | $413 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $64 | $479 | $1,340 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $64 | $342 | $815 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $64 | $262 | $611 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $57 | $509 | $1,407 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $64 | $465 | $1,121 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $463 | $1,130 | $1,849 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $449 | $1,946 | $3,266 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $205 | $3,886 | $6,598 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,252 | $5,038 | $7,744 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $3,746 | $5,640 | $8,619 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $552 | $1,057 | $1,677 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $813 | $1,308 | $1,866 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $8 | $23 | $49 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $5 | $16 | $22 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $9 | $18 | $27 |
| Cardiovascular stress test CPT 93015 • Cardiology | $113 | $160 | $242 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $56 | $87 | $123 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $92 | $156 | $261 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $153 | $404 | $630 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $50 | $314 | $780 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $66 | $244 | $690 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $105 | $334 | $829 |
| Stress echocardiography CPT 93350 • Cardiology | $66 | $231 | $654 |
| Left and right heart catheterization CPT 93452 • Cardiology | $359 | $1,119 | $3,280 |
| Left heart catheterization CPT 93458 • Cardiology | $230 | $1,248 | $3,767 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $507 | $1,470 | $4,049 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $173 | $337 | $631 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $23 | $103 | $269 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $55 | $368 | $800 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $76 | $327 | $620 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $31 | $95 | $201 |