| Allergen specific IgE each allergen CPT 86003 • Allergy | $2 | $5 | $9 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $2 | $5 | $11 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $6 | $7 |
| Allergy testing insect venoms CPT 95017 • Allergy | $7 | $9 | $12 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $6 | $15 | $30 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $7 | $9 | $12 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $8 | $11 | $13 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $9 | $13 | $16 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $2 | $12 | $22 |
| Sublingual allergen immunotherapy CPT 95199 • Allergy | $0 | $0 | $0 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $62 | $110 | $270 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $62 | $110 | $270 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $62 | $110 | $270 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $62 | $92 | $180 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $62 | $112 | $284 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $62 | $129 | $365 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $62 | $150 | $473 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $62 | $88 | $162 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $62 | $177 | $608 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $62 | $120 | $324 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $62 | $137 | $405 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $62 | $1,015 | $3,150 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $62 | $851 | $3,150 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $339 | $751 | $1,183 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $131 | $1,042 | $1,313 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $1,067 | $2,273 | $2,653 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $1,231 | $3,224 | $5,641 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $1,576 | $3,113 | $3,687 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $433 | $742 | $994 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $618 | $782 | $863 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $14 | $21 | $27 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $8 | $12 | $16 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $9 | $11 | $13 |
| Cardiovascular stress test CPT 93015 • Cardiology | $73 | $117 | $156 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $37 | $58 | $72 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $86 | $129 | $157 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $86 | $154 | $224 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $65 | $201 | $421 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $65 | $184 | $329 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $159 | $279 | $601 |
| Stress echocardiography CPT 93350 • Cardiology | $155 | $205 | $282 |
| Left and right heart catheterization CPT 93452 • Cardiology | $257 | $759 | $1,231 |
| Left heart catheterization CPT 93458 • Cardiology | $318 | $1,050 | $2,256 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $460 | $975 | $1,692 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $43 | $187 | $280 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $17 | $94 | $160 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $139 | $306 | $406 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $48 | $188 | $282 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $29 | $70 | $98 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $13 | $71 | $112 |