| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $7 | $12 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $4 | $7 | $11 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $4 | $7 |
| Allergy testing insect venoms CPT 95017 • Allergy | $4 | $14 | $24 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $7 | $25 | $49 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $1 | $10 | $20 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $8 | $15 | $21 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $12 | $20 | $32 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $12 | $20 | $31 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $64 | $351 | $611 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $64 | $300 | $448 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $64 | $351 | $611 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $64 | $240 | $407 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $64 | $348 | $523 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $64 | $443 | $672 |
| 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 | $64 | $407 | $713 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $64 | $351 | $611 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $64 | $520 | $981 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $64 | $469 | $815 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $64 | $351 | $611 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $64 | $506 | $857 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $64 | $571 | $1,121 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $486 | $818 | $1,531 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $137 | $1,446 | $2,338 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $247 | $2,231 | $4,706 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $1,141 | $2,834 | $5,533 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $1,267 | $2,464 | $3,744 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $433 | $888 | $1,328 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $481 | $756 | $1,309 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $14 | $20 | $27 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $5 | $17 | $22 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $14 | $20 |
| Cardiovascular stress test CPT 93015 • Cardiology | $69 | $135 | $189 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $36 | $73 | $101 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $69 | $169 | $273 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $90 | $220 | $364 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $75 | $260 | $566 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $56 | $240 | $545 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $225 | $335 | $578 |
| Stress echocardiography CPT 93350 • Cardiology | $155 | $277 | $574 |
| Left and right heart catheterization CPT 93452 • Cardiology | $721 | $1,330 | $1,956 |
| Left heart catheterization CPT 93458 • Cardiology | $670 | $916 | $1,388 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $654 | $1,288 | $2,644 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $36 | $211 | $487 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $14 | $92 | $214 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $175 | $382 | $626 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $27 | $269 | $475 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $23 | $96 | $141 |