| Allergen specific IgE each allergen CPT 86003 • Allergy | $1 | $3 | $6 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $1 | $4 | $9 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $8 | $11 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $14 | $24 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $7 | $11 | $16 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $8 | $14 | $22 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $9 | $17 | $27 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $6 | $18 | $32 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $12 | $21 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $38 | $672 | $1,480 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $44 | $715 | $2,072 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $44 | $420 | $888 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $101 | $387 | $666 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $101 | $662 | $1,184 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $101 | $840 | $1,332 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $38 | $939 | $2,220 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $44 | $419 | $888 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $101 | $914 | $1,628 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $52 | $774 | $1,332 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $52 | $657 | $1,406 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $52 | $808 | $1,776 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $104 | $1,443 | $4,500 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $623 | $1,177 | $1,988 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $220 | $469 | $719 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $1,467 | $1,503 | $1,538 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $1,719 | $1,762 | $1,805 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,008 | $5,659 | $9,311 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $99 | $910 | $1,721 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $274 | $1,081 | $1,918 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $14 | $28 | $40 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $6 | $12 | $17 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $2 | $13 | $23 |
| Cardiovascular stress test CPT 93015 • Cardiology | $36 | $73 | $129 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $7 | $17 | $26 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $16 | $79 | $153 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $28 | $447 | $867 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $61 | $301 | $730 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $68 | $419 | $652 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $84 | $160 | $211 |
| Stress echocardiography CPT 93350 • Cardiology | $55 | $102 | $127 |
| Left and right heart catheterization CPT 93452 • Cardiology | $727 | $1,465 | $2,202 |
| Left heart catheterization CPT 93458 • Cardiology | $277 | $470 | $591 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $879 | $985 | $1,090 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $69 | $126 | $201 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $21 | $53 | $74 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $51 | $75 | $105 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $60 | $249 | $520 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $2 | $25 | $48 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $15 | $111 | $208 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $3 | $79 | $157 |