| Allergen specific IgE each allergen CPT 86003 • Allergy | $1 | $2 | $3 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $7 | $13 | $19 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $5 | $6 |
| Allergy testing insect venoms CPT 95017 • Allergy | $7 | $12 | $23 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $38 | $50 | $62 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $1 | $6 | $10 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $9 | $18 | $27 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $11 | $14 | $22 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $9 | $13 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $55 | $58 | $61 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $42 | $502 | $732 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $55 | $394 | $732 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $55 | $67 | $79 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $42 | $60 | $79 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $42 | $570 | $1,098 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $37 | $40 | $42 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $40 | $284 | $732 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $42 | $61 | $79 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $50 | $64 | $79 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $42 | $61 | $79 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $55 | $67 | $79 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $38 | $52 | $79 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $567 | $978 | $1,762 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,807 | $2,453 | $3,100 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,164 | $2,935 | $3,707 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,541 | $4,783 | $7,415 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $3,845 | $4,373 | $4,901 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $928 | $1,071 | $1,214 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $485 | $832 | $1,180 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $11 | $32 | $54 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $5 | $16 | $27 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $13 | $19 | $27 |
| Cardiovascular stress test CPT 93015 • Cardiology | $62 | $159 | $254 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $50 | $56 | $62 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $157 | $237 | $317 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $172 | $510 | $942 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $378 | $385 | $393 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $102 | $441 | $648 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $164 | $366 | $770 |
| Stress echocardiography CPT 93350 • Cardiology | $173 | $328 | $593 |
| Left and right heart catheterization CPT 93452 • Cardiology | $2,387 | $2,626 | $2,866 |
| Left heart catheterization CPT 93458 • Cardiology | $251 | $676 | $948 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $507 | $1,608 | $3,661 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $60 | $241 | $343 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $24 | $119 | $271 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $59 | $444 | $811 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $69 | $103 | $138 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $51 | $82 | $110 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $56 | $95 | $133 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $31 | $47 | $70 |