| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $7 | $11 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $4 | $11 | $16 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $5 | $7 |
| Allergy testing insect venoms CPT 95017 • Allergy | $4 | $8 | $13 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $7 | $9 | $12 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $5 | $9 | $13 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $10 | $13 | $18 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $12 | $16 | $21 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $7 | $14 |
| Sublingual allergen immunotherapy CPT 95199 • Allergy | $0 | $0 | $0 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $40 | $293 | $432 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $40 | $361 | $611 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $40 | $361 | $611 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $40 | $245 | $407 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $40 | $340 | $504 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $40 | $535 | $917 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $40 | $340 | $504 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $40 | $361 | $611 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $40 | $544 | $981 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $40 | $386 | $576 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $40 | $361 | $611 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $40 | $491 | $857 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $40 | $718 | $1,682 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $676 | $747 | $816 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $897 | $1,171 | $1,437 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $294 | $1,985 | $2,931 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $303 | $2,257 | $3,441 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $336 | $2,470 | $3,822 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $516 | $622 | $820 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $574 | $691 | $911 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $14 | $23 | $28 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $6 | $12 | $18 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $11 | $13 |
| Cardiovascular stress test CPT 93015 • Cardiology | $72 | $106 | $121 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $38 | $59 | $68 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $72 | $120 | $169 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $80 | $219 | $450 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $98 | $187 | $259 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $92 | $206 | $315 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $104 | $302 | $389 |
| Stress echocardiography CPT 93350 • Cardiology | $92 | $162 | $254 |
| Left and right heart catheterization CPT 93452 • Cardiology | $285 | $894 | $1,420 |
| Left heart catheterization CPT 93458 • Cardiology | $287 | $852 | $2,315 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $395 | $721 | $1,191 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $37 | $137 | $238 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $83 | $106 | $139 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $59 | $186 | $267 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $52 | $164 | $231 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $15 | $46 | $98 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $22 | $37 | $66 |