| Allergen specific IgE each allergen CPT 86003 • Allergy | $4 | $5 | $6 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $3 | $7 | $11 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $5 | $9 |
| Allergy testing insect venoms CPT 95017 • Allergy | $4 | $8 | $12 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $7 | $16 | $30 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $6 | $8 | $12 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $8 | $10 | $13 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $10 | $13 | $16 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $4 | $12 | $25 |
| Sublingual allergen immunotherapy CPT 95199 • Allergy | $0 | $0 | $0 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $57 | $156 | $333 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $30 | $147 | $333 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $57 | $119 | $222 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $57 | $95 | $148 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $57 | $175 | $389 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $57 | $212 | $500 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $57 | $175 | $389 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $57 | $156 | $333 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $57 | $212 | $500 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $57 | $144 | $296 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $57 | $156 | $333 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $57 | $620 | $1,723 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $57 | $570 | $1,573 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $339 | $699 | $1,177 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $981 | $1,543 | $2,078 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $356 | $2,284 | $4,199 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,347 | $3,698 | $4,928 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $1,576 | $3,260 | $5,485 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $509 | $716 | $1,067 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $566 | $796 | $1,187 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $16 | $24 | $33 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $7 | $10 | $14 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $9 | $12 | $17 |
| Cardiovascular stress test CPT 93015 • Cardiology | $83 | $107 | $154 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $35 | $45 | $52 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $77 | $90 | $110 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $105 | $190 | $311 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $65 | $196 | $247 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $65 | $228 | $439 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $121 | $277 | $527 |
| Stress echocardiography CPT 93350 • Cardiology | $154 | $238 | $416 |
| Left and right heart catheterization CPT 93452 • Cardiology | $247 | $835 | $1,099 |
| Left heart catheterization CPT 93458 • Cardiology | $307 | $1,246 | $2,397 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $460 | $1,226 | $2,577 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $28 | $218 | $402 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $92 | $115 | $171 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $31 | $279 | $509 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $139 | $243 | $395 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $22 | $66 | $98 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $35 | $78 | $112 |