| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $4 | $6 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $4 | $6 | $7 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $6 | $12 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $7 | $16 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $5 | $20 | $40 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $1 | $8 | $13 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $10 | $15 | $20 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $12 | $16 | $23 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $17 | $25 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $4 | $129 | $300 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $4 | $156 | $405 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $4 | $156 | $405 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $4 | $109 | $270 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $4 | $179 | $473 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $4 | $226 | $608 |
| Anesthesia for upper GI endoscopy CPT 00740 • Anesthesia | $300 | $300 | $300 |
| Anesthesia for lower GI endoscopy CPT 00810 • Anesthesia | $300 | $300 | $300 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $4 | $148 | $350 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $4 | $156 | $405 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $4 | $376 | $981 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $4 | $203 | $540 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $4 | $156 | $405 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $4 | $154 | $540 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $4 | $199 | $650 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $483 | $4,920 | $26,232 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $275 | $16,248 | $93,042 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $1,937 | $2,868 | $6,331 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,275 | $3,377 | $6,331 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,467 | $3,526 | $6,331 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $510 | $2,748 | $13,195 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $568 | $2,813 | $13,195 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $15 | $22 | $36 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $7 | $13 | $22 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $11 | $16 |
| Cardiovascular stress test CPT 93015 • Cardiology | $71 | $103 | $167 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $35 | $57 | $98 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $72 | $121 | $175 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $85 | $142 | $277 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $57 | $172 | $268 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $64 | $150 | $260 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $233 | $344 | $586 |
| Stress echocardiography CPT 93350 • Cardiology | $60 | $189 | $380 |
| Left and right heart catheterization CPT 93452 • Cardiology | $310 | $2,359 | $10,761 |
| Left heart catheterization CPT 93458 • Cardiology | $283 | $2,605 | $10,761 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $429 | $2,746 | $10,761 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $41 | $227 | $453 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $13 | $98 | $178 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $40 | $280 | $573 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $35 | $153 | $245 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $12 | $359 | $1,928 |