| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $8 | $13 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $5 | $11 | $20 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $8 | $15 |
| Allergy testing insect venoms CPT 95017 • Allergy | $4 | $8 | $13 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $8 | $23 | $32 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $6 | $9 | $12 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $9 | $14 | $20 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $10 | $15 | $19 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $4 | $9 | $22 |
| Sublingual allergen immunotherapy CPT 95199 • Allergy | $0 | $0 | $0 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $40 | $205 | $384 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $40 | $253 | $576 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $40 | $253 | $576 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $40 | $149 | $256 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $40 | $289 | $672 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $40 | $289 | $576 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $40 | $233 | $448 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $40 | $251 | $576 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $40 | $361 | $864 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $40 | $325 | $768 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $40 | $251 | $576 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $40 | $452 | $1,275 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $40 | $566 | $1,838 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $347 | $681 | $856 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $133 | $1,105 | $1,622 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,344 | $3,342 | $4,974 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,519 | $3,345 | $3,882 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $350 | $3,180 | $5,831 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $509 | $654 | $993 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $566 | $735 | $1,103 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $15 | $24 | $37 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $10 | $17 | $23 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $11 | $14 |
| Cardiovascular stress test CPT 93015 • Cardiology | $83 | $118 | $169 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $44 | $73 | $104 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $82 | $152 | $223 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $88 | $175 | $280 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $69 | $214 | $305 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $128 | $220 | $337 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $158 | $262 | $375 |
| Stress echocardiography CPT 93350 • Cardiology | $97 | $161 | $234 |
| Left and right heart catheterization CPT 93452 • Cardiology | $285 | $802 | $1,538 |
| Left heart catheterization CPT 93458 • Cardiology | $307 | $688 | $1,511 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $395 | $1,206 | $2,115 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $132 | $249 | $362 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $92 | $138 | $199 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $31 | $296 | $506 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $56 | $173 | $271 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $19 | $46 | $74 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $26 | $68 | $135 |