| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $5 | $8 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $5 | $6 | $12 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $5 | $7 |
| Allergy testing insect venoms CPT 95017 • Allergy | $4 | $8 | $15 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $8 | $14 | $35 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $5 | $8 | $14 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $7 | $12 | $16 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $9 | $14 | $18 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $4 | $10 | $12 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $30 | $196 | $684 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $30 | $196 | $684 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $30 | $196 | $684 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $30 | $156 | $532 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $30 | $217 | $760 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $30 | $259 | $912 |
| Anesthesia for upper GI endoscopy CPT 00740 • Anesthesia | $300 | $300 | $300 |
| Anesthesia for lower GI endoscopy CPT 00810 • Anesthesia | $300 | $300 | $300 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $30 | $217 | $760 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $30 | $196 | $684 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $30 | $259 | $912 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $30 | $238 | $836 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $30 | $196 | $684 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $30 | $206 | $836 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $30 | $254 | $684 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $555 | $671 | $834 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $979 | $1,121 | $1,262 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $1,989 | $2,338 | $2,951 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,336 | $2,616 | $3,024 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,601 | $2,900 | $3,358 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $505 | $626 | $721 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $562 | $719 | $931 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $13 | $21 | $28 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $5 | $12 | $18 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $7 | $10 | $11 |
| Cardiovascular stress test CPT 93015 • Cardiology | $65 | $96 | $112 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $31 | $53 | $68 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $68 | $114 | $169 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $88 | $200 | $395 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $50 | $145 | $231 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $77 | $185 | $289 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $213 | $258 | $338 |
| Stress echocardiography CPT 93350 • Cardiology | $66 | $138 | $221 |
| Left and right heart catheterization CPT 93452 • Cardiology | $188 | $650 | $967 |
| Left heart catheterization CPT 93458 • Cardiology | $351 | $749 | $1,204 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $395 | $983 | $1,330 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $34 | $133 | $254 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $20 | $88 | $126 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $32 | $216 | $427 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $38 | $166 | $278 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $19 | $51 | $91 |