| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $7 | $11 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $5 | $11 | $16 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $5 | $7 |
| Allergy testing insect venoms CPT 95017 • Allergy | $4 | $7 | $13 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $7 | $9 | $12 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $5 | $8 | $13 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $9 | $13 | $18 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $10 | $16 | $21 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $4 | $8 | $14 |
| Sublingual allergen immunotherapy CPT 95199 • Allergy | $0 | $0 | $0 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $40 | $355 | $594 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $40 | $289 | $432 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $40 | $355 | $594 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $40 | $241 | $396 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $40 | $412 | $693 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $40 | $526 | $891 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $40 | $412 | $693 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $40 | $289 | $432 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $40 | $637 | $981 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $40 | $469 | $792 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $40 | $289 | $432 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $40 | $818 | $1,838 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $40 | $549 | $1,175 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $347 | $643 | $816 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $133 | $980 | $1,437 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,344 | $2,659 | $2,989 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $368 | $2,274 | $3,441 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,504 | $3,012 | $3,822 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $509 | $620 | $820 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $566 | $689 | $911 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $18 | $24 | $28 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $10 | $13 | $18 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $11 | $13 |
| Cardiovascular stress test CPT 93015 • Cardiology | $83 | $109 | $121 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $44 | $61 | $68 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $82 | $122 | $169 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $80 | $193 | $450 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $98 | $181 | $259 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $68 | $191 | $315 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $113 | $304 | $389 |
| Stress echocardiography CPT 93350 • Cardiology | $92 | $157 | $254 |
| Left and right heart catheterization CPT 93452 • Cardiology | $250 | $735 | $1,420 |
| Left heart catheterization CPT 93458 • Cardiology | $351 | $1,004 | $2,315 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $395 | $774 | $1,191 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $60 | $161 | $238 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $80 | $105 | $139 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $59 | $168 | $267 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $52 | $166 | $231 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $11 | $45 | $98 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $26 | $38 | $66 |