| Allergen specific IgE each allergen CPT 86003 • Allergy | $4 | $6 | $11 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $4 | $5 | $7 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $5 | $9 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $5 | $7 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $10 | $16 | $20 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $1 | $4 | $8 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $7 | $9 | $12 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $8 | $13 | $23 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $10 | $20 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $15 | $95 | $284 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $15 | $95 | $284 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $15 | $130 | $426 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $15 | $115 | $284 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $15 | $148 | $496 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $15 | $206 | $638 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $15 | $106 | $331 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $15 | $105 | $284 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $15 | $183 | $638 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $15 | $184 | $567 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $15 | $95 | $284 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $15 | $165 | $567 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $15 | $95 | $284 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $355 | $794 | $1,727 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $627 | $1,133 | $1,991 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $1,268 | $2,339 | $4,194 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $1,489 | $2,756 | $4,958 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $774 | $1,884 | $2,677 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $359 | $703 | $1,377 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $399 | $757 | $1,530 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $10 | $24 | $64 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $4 | $14 | $41 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $6 | $11 | $24 |
| Cardiovascular stress test CPT 93015 • Cardiology | $49 | $95 | $200 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $24 | $50 | $106 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $52 | $105 | $233 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $78 | $243 | $580 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $156 | $234 | $328 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $63 | $126 | $196 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $103 | $180 | $268 |
| Stress echocardiography CPT 93350 • Cardiology | $131 | $262 | $500 |
| Left and right heart catheterization CPT 93452 • Cardiology | $651 | $996 | $1,575 |
| Left heart catheterization CPT 93458 • Cardiology | $285 | $948 | $1,930 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $305 | $707 | $1,151 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $38 | $195 | $598 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $31 | $62 | $80 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $42 | $246 | $529 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $36 | $162 | $303 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $11 | $41 | $66 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $56 | $67 | $76 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $39 | $78 | $114 |