| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $7 | $11 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $5 | $9 | $16 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $6 | $7 |
| Allergy testing insect venoms CPT 95017 • Allergy | $4 | $9 | $14 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $8 | $30 | $50 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $1 | $7 | $13 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $13 | $17 | $22 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $16 | $21 | $28 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $4 | $20 | $38 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $3 | $188 | $595 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $3 | $176 | $595 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $3 | $262 | $893 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $3 | $138 | $397 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $3 | $212 | $695 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $3 | $262 | $893 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $3 | $212 | $695 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $3 | $262 | $893 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $3 | $562 | $1,340 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $3 | $237 | $794 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $3 | $262 | $893 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $3 | $323 | $1,137 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $3 | $596 | $2,230 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $536 | $693 | $795 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $882 | $1,361 | $2,043 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $459 | $2,502 | $4,073 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $472 | $2,912 | $4,776 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,467 | $3,330 | $3,958 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $510 | $702 | $805 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $781 | $956 | $1,265 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $15 | $22 | $27 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $10 | $13 | $17 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $10 | $14 | $19 |
| Cardiovascular stress test CPT 93015 • Cardiology | $113 | $138 | $176 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $59 | $74 | $91 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $111 | $144 | $204 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $69 | $251 | $429 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $187 | $270 | $343 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $204 | $319 | $521 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $206 | $364 | $625 |
| Stress echocardiography CPT 93350 • Cardiology | $105 | $239 | $492 |
| Left and right heart catheterization CPT 93452 • Cardiology | $359 | $754 | $1,087 |
| Left heart catheterization CPT 93458 • Cardiology | $448 | $1,059 | $1,666 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $507 | $1,486 | $3,081 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $55 | $243 | $486 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $18 | $118 | $208 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $192 | $363 | $621 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $47 | $239 | $478 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $19 | $88 | $168 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $26 | $53 | $83 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $58 | $169 | $248 |