| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $6 | $8 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $7 | $9 | $11 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $8 | $15 |
| Allergy testing insect venoms CPT 95017 • Allergy | $9 | $14 | $18 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $18 | $33 | $47 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $2 | $5 | $8 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $11 | $15 | $17 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $13 | $18 | $28 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $13 | $15 | $17 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $46 | $46 | $46 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $142 | $379 | $606 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $142 | $168 | $194 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $46 | $108 | $170 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $65 | $362 | $707 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $65 | $454 | $909 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $65 | $178 | $291 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $65 | $288 | $606 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $149 | $490 | $909 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $142 | $478 | $808 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $77 | $325 | $606 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $77 | $184 | $291 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $46 | $1,042 | $2,474 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $604 | $751 | $1,060 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,146 | $1,415 | $1,909 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,164 | $2,912 | $3,553 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $4,758 | $4,989 | $5,223 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $3,149 | $3,966 | $4,783 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $876 | $957 | $1,038 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $691 | $918 | $1,156 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $8 | $20 | $31 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $6 | $9 | $14 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $11 | $16 |
| Cardiovascular stress test CPT 93015 • Cardiology | $34 | $83 | $141 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $34 | $45 | $55 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $92 | $140 | $188 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $133 | $187 | $241 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $81 | $103 | $123 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $140 | $235 | $349 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $164 | $320 | $573 |
| Stress echocardiography CPT 93350 • Cardiology | $90 | $161 | $233 |
| Left and right heart catheterization CPT 93452 • Cardiology | $439 | $464 | $490 |
| Left heart catheterization CPT 93458 • Cardiology | $431 | $739 | $1,269 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $507 | $784 | $1,333 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $235 | $271 | $332 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $16 | $69 | $167 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $69 | $234 | $356 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $51 | $202 | $302 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $29 | $63 | $110 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $59 | $89 | $118 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $102 | $144 | $216 |