| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $4 | $6 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $4 | $5 | $6 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $7 | $17 |
| Allergy testing insect venoms CPT 95017 • Allergy | $4 | $13 | $24 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $7 | $26 | $51 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $1 | $9 | $20 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $10 | $16 | $27 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $12 | $19 | $32 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $4 | $19 | $39 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $30 | $247 | $611 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $30 | $247 | $611 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $30 | $196 | $407 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $30 | $138 | $272 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $30 | $225 | $475 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $30 | $358 | $917 |
| 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 | $30 | $284 | $713 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $30 | $196 | $407 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $30 | $358 | $917 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $30 | $321 | $815 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $30 | $247 | $611 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $30 | $317 | $857 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $30 | $457 | $1,121 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $300 | $808 | $1,531 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $884 | $1,376 | $2,261 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $1,719 | $2,779 | $4,639 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,519 | $3,401 | $5,451 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $359 | $3,057 | $6,073 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $482 | $846 | $1,328 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $566 | $866 | $1,474 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $13 | $25 | $42 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $6 | $13 | $21 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $7 | $13 | $20 |
| Cardiovascular stress test CPT 93015 • Cardiology | $67 | $133 | $222 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $35 | $67 | $101 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $71 | $165 | $273 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $85 | $227 | $364 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $56 | $194 | $432 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $63 | $158 | $260 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $97 | $258 | $328 |
| Stress echocardiography CPT 93350 • Cardiology | $73 | $155 | $246 |
| Left and right heart catheterization CPT 93452 • Cardiology | $613 | $1,042 | $1,762 |
| Left heart catheterization CPT 93458 • Cardiology | $692 | $1,213 | $1,834 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $908 | $1,184 | $1,445 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $37 | $152 | $249 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $12 | $64 | $108 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $190 | $317 | $496 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $175 | $262 | $398 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $10 | $66 | $141 |