| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $9 | $13 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $5 | $13 | $20 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $7 | $15 |
| Allergy testing insect venoms CPT 95017 • Allergy | $4 | $8 | $13 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $8 | $24 | $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 | $16 | $19 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $4 | $8 | $22 |
| Sublingual allergen immunotherapy CPT 95199 • Allergy | $0 | $0 | $0 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $40 | $214 | $384 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $40 | $248 | $576 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $40 | $242 | $576 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $40 | $155 | $256 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $40 | $284 | $672 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $40 | $320 | $576 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $40 | $244 | $448 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $40 | $246 | $576 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $40 | $355 | $864 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $40 | $319 | $768 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $40 | $247 | $576 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $40 | $383 | $1,275 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $40 | $405 | $1,838 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $347 | $743 | $856 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $133 | $1,181 | $1,622 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,344 | $3,285 | $4,974 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,519 | $3,382 | $3,882 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $350 | $3,322 | $5,831 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $509 | $722 | $993 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $566 | $751 | $1,103 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $15 | $27 | $37 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $10 | $17 | $23 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $12 | $14 |
| Cardiovascular stress test CPT 93015 • Cardiology | $83 | $128 | $169 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $44 | $79 | $104 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $82 | $166 | $223 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $88 | $196 | $280 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $69 | $260 | $359 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $128 | $287 | $456 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $158 | $312 | $513 |
| Stress echocardiography CPT 93350 • Cardiology | $97 | $167 | $234 |
| Left and right heart catheterization CPT 93452 • Cardiology | $285 | $854 | $1,538 |
| Left heart catheterization CPT 93458 • Cardiology | $304 | $736 | $1,511 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $395 | $1,411 | $2,115 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $41 | $193 | $362 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $20 | $127 | $199 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $31 | $317 | $506 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $56 | $177 | $271 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $17 | $48 | $74 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $26 | $72 | $135 |