| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $8 | $15 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $4 | $15 | $23 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $5 | $7 |
| Allergy testing insect venoms CPT 95017 • Allergy | $6 | $9 | $14 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $20 | $25 | $35 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $5 | $8 | $13 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $8 | $12 | $15 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $9 | $13 | $18 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $4 | $11 | $24 |
| Sublingual allergen immunotherapy CPT 95199 • Allergy | $0 | $0 | $0 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $64 | $250 | $463 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $64 | $475 | $899 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $64 | $475 | $899 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $64 | $212 | $399 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $64 | $331 | $540 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $64 | $419 | $695 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $64 | $551 | $1,049 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $64 | $475 | $899 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $64 | $419 | $695 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $64 | $493 | $799 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $64 | $475 | $899 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $40 | $719 | $1,500 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $40 | $618 | $1,350 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $731 | $817 | $895 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $152 | $969 | $1,574 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $319 | $1,960 | $3,218 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $1,448 | $2,583 | $3,783 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,648 | $3,593 | $4,220 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $509 | $657 | $916 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $566 | $731 | $1,019 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $13 | $22 | $28 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $6 | $13 | $21 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $12 | $14 |
| Cardiovascular stress test CPT 93015 • Cardiology | $83 | $104 | $117 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $52 | $79 | $104 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $135 | $149 | $169 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $88 | $259 | $533 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $101 | $221 | $379 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $67 | $137 | $339 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $181 | $319 | $404 |
| Stress echocardiography CPT 93350 • Cardiology | $84 | $184 | $310 |
| Left and right heart catheterization CPT 93452 • Cardiology | $481 | $1,056 | $1,763 |
| Left heart catheterization CPT 93458 • Cardiology | $1,015 | $1,284 | $1,751 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $645 | $1,245 | $1,906 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $28 | $226 | $324 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $92 | $117 | $137 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $31 | $251 | $411 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $37 | $181 | $316 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $19 | $55 | $102 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $27 | $68 | $121 |