| Allergen specific IgE each allergen CPT 86003 • Allergy | $2 | $5 | $7 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $1 | $3 | $5 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $5 | $8 | $12 |
| Allergy testing insect venoms CPT 95017 • Allergy | $9 | $14 | $25 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $24 | $32 | $49 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $6 | $11 | $19 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $1 | $16 | $27 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $6 | $20 | $33 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $6 | $10 | $19 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $33 | $169 | $496 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $34 | $112 | $272 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $39 | $176 | $542 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $33 | $151 | $425 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $33 | $199 | $620 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $34 | $399 | $1,416 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $39 | $144 | $389 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $39 | $120 | $319 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $33 | $196 | $602 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $34 | $224 | $714 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $33 | $177 | $555 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $33 | $150 | $442 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $33 | $226 | $730 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $86 | $771 | $1,655 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $743 | $2,367 | $4,991 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $1,510 | $4,103 | $10,308 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,330 | $4,273 | $6,880 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $1,291 | $7,108 | $13,514 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $431 | $1,106 | $1,782 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $128 | $1,119 | $1,978 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $11 | $24 | $41 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $3 | $12 | $18 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $5 | $12 | $21 |
| Cardiovascular stress test CPT 93015 • Cardiology | $109 | $143 | $208 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $14 | $70 | $121 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $132 | $190 | $289 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $86 | $236 | $535 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $87 | $339 | $647 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $74 | $343 | $723 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $158 | $395 | $707 |
| Stress echocardiography CPT 93350 • Cardiology | $97 | $179 | $236 |
| Left and right heart catheterization CPT 93452 • Cardiology | $1,420 | $2,019 | $2,705 |
| Left heart catheterization CPT 93458 • Cardiology | $524 | $1,513 | $3,103 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $465 | $823 | $1,268 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $71 | $320 | $560 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $110 | $157 | $214 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $32 | $293 | $594 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $38 | $138 | $364 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $9 | $32 | $45 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $40 | $149 | $239 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $17 | $157 | $294 |