| Allergen specific IgE each allergen CPT 86003 • Allergy | $2 | $6 | $8 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $3 | $9 | $13 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $9 | $15 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $9 | $14 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $14 | $34 | $47 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $8 | $12 | $16 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $12 | $16 | $21 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $14 | $27 | $47 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $7 | $18 | $31 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $30 | $303 | $540 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $30 | $240 | $540 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $142 | $472 | $606 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $149 | $290 | $360 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $42 | $284 | $630 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $30 | $151 | $388 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $42 | $332 | $707 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $30 | $257 | $606 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $149 | $570 | $909 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $42 | $353 | $808 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $30 | $253 | $540 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $30 | $298 | $720 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $30 | $616 | $1,746 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $651 | $1,355 | $2,874 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $39 | $1,197 | $2,054 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $57 | $3,593 | $10,308 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $341 | $5,246 | $12,121 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $1,783 | $5,092 | $7,934 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $515 | $1,148 | $1,782 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $90 | $957 | $1,978 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $18 | $34 | $42 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $6 | $14 | $24 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $15 | $21 |
| Cardiovascular stress test CPT 93015 • Cardiology | $38 | $103 | $158 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $33 | $66 | $121 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $14 | $259 | $475 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $279 | $407 | $535 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $311 | $325 | $349 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $93 | $224 | $469 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $139 | $503 | $1,053 |
| Stress echocardiography CPT 93350 • Cardiology | $97 | $305 | $528 |
| Left and right heart catheterization CPT 93452 • Cardiology | $958 | $1,286 | $1,615 |
| Left heart catheterization CPT 93458 • Cardiology | $403 | $1,202 | $3,389 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $424 | $1,171 | $2,286 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $97 | $289 | $465 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $104 | $155 | $181 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $124 | $359 | $529 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $43 | $152 | $453 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $45 | $80 | $126 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $63 | $70 | $77 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $7 | $92 | $216 |