| Allergen specific IgE each allergen CPT 86003 • Allergy | $2 | $6 | $11 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $3 | $7 | $14 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $5 | $6 |
| Allergy testing insect venoms CPT 95017 • Allergy | $4 | $8 | $13 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $7 | $21 | $34 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $5 | $8 | $13 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $8 | $12 | $14 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $10 | $15 | $18 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $11 | $21 |
| Sublingual allergen immunotherapy CPT 95199 • Allergy | $0 | $0 | $0 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $40 | $205 | $342 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $40 | $202 | $342 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $40 | $224 | $342 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $40 | $142 | $228 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $40 | $258 | $399 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $40 | $326 | $513 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $40 | $258 | $399 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $40 | $224 | $342 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $40 | $384 | $806 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $40 | $262 | $456 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $40 | $224 | $342 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $40 | $760 | $1,739 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $40 | $771 | $1,623 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $507 | $684 | $826 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $152 | $996 | $1,622 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $319 | $2,352 | $4,974 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,134 | $2,923 | $3,882 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $1,577 | $2,525 | $3,019 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $508 | $637 | $857 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $565 | $700 | $917 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $15 | $22 | $30 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $7 | $13 | $19 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $10 | $13 |
| Cardiovascular stress test CPT 93015 • Cardiology | $75 | $93 | $112 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $41 | $52 | $68 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $73 | $113 | $169 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $86 | $142 | $282 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $58 | $151 | $231 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $68 | $216 | $341 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $113 | $310 | $417 |
| Stress echocardiography CPT 93350 • Cardiology | $159 | $228 | $375 |
| Left and right heart catheterization CPT 93452 • Cardiology | $294 | $651 | $1,281 |
| Left heart catheterization CPT 93458 • Cardiology | $367 | $771 | $1,179 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $429 | $1,056 | $1,748 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $32 | $166 | $329 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $86 | $98 | $126 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $31 | $245 | $421 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $148 | $225 | $318 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $19 | $49 | $99 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $15 | $47 | $85 |