| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $5 | $7 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $5 | $10 | $14 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $4 | $4 |
| Allergy testing insect venoms CPT 95017 • Allergy | $4 | $7 | $10 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $8 | $16 | $23 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $1 | $4 | $5 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $8 | $11 | $14 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $9 | $14 | $18 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $4 | $9 | $17 |
| Sublingual allergen immunotherapy CPT 95199 • Allergy | $0 | $0 | $0 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $40 | $188 | $336 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $40 | $188 | $336 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $40 | $188 | $336 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $40 | $132 | $224 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $40 | $216 | $392 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $40 | $272 | $504 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $40 | $216 | $392 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $40 | $188 | $336 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $40 | $272 | $504 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $40 | $244 | $448 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $40 | $188 | $336 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $40 | $496 | $1,000 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $40 | $425 | $900 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $670 | $708 | $731 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $834 | $1,065 | $1,181 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $279 | $1,685 | $2,433 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $322 | $1,900 | $2,858 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,192 | $2,672 | $3,177 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $433 | $555 | $634 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $481 | $617 | $704 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $15 | $20 | $28 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $5 | $11 | $18 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $10 | $12 |
| Cardiovascular stress test CPT 93015 • Cardiology | $71 | $97 | $112 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $37 | $53 | $68 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $70 | $108 | $169 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $88 | $156 | $248 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $58 | $145 | $231 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $109 | $209 | $289 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $134 | $247 | $328 |
| Stress echocardiography CPT 93350 • Cardiology | $135 | $188 | $246 |
| Left and right heart catheterization CPT 93452 • Cardiology | $211 | $302 | $409 |
| Left heart catheterization CPT 93458 • Cardiology | $351 | $676 | $1,178 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $294 | $652 | $1,269 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $113 | $178 | $238 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $78 | $92 | $103 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $139 | $213 | $267 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $140 | $184 | $231 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $19 | $49 | $83 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $14 | $46 | $97 |