| Allergen specific IgE each allergen CPT 86003 • Allergy | $2 | $4 | $6 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $2 | $7 | $16 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $8 | $14 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $7 | $10 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $21 | $31 | $49 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $5 | $8 | $10 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $11 | $13 | $14 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $13 | $15 | $18 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $4 | $15 | $23 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $30 | $169 | $413 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $30 | $238 | $619 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $30 | $329 | $893 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $30 | $123 | $275 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $30 | $263 | $695 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $30 | $329 | $893 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $30 | $192 | $482 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $30 | $169 | $413 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $62 | $488 | $1,340 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $30 | $307 | $826 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $30 | $169 | $413 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $30 | $303 | $814 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $30 | $386 | $1,065 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $731 | $914 | $1,214 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $882 | $1,080 | $1,181 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $269 | $1,675 | $2,412 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,252 | $3,290 | $5,099 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,648 | $3,026 | $3,746 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $538 | $833 | $1,202 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $599 | $732 | $842 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $15 | $27 | $39 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $8 | $12 | $18 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $11 | $12 | $13 |
| Cardiovascular stress test CPT 93015 • Cardiology | $112 | $130 | $165 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $59 | $62 | $68 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $113 | $141 | $169 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $86 | $199 | $404 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $229 | $332 | $535 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $205 | $254 | $298 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $246 | $296 | $328 |
| Stress echocardiography CPT 93350 • Cardiology | $105 | $178 | $246 |
| Left and right heart catheterization CPT 93452 • Cardiology | $359 | $950 | $1,281 |
| Left heart catheterization CPT 93458 • Cardiology | $448 | $1,432 | $2,369 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $507 | $1,195 | $1,633 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $238 | $242 | $249 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $103 | $107 | $111 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $39 | $207 | $315 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $34 | $170 | $245 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $19 | $75 | $112 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $27 | $78 | $153 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $55 | $129 | $225 |