| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $5 | $7 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $5 | $6 | $10 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $7 | $15 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $4 | $6 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $5 | $15 | $29 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $1 | $5 | $7 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $8 | $11 | $14 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $9 | $13 | $18 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $6 | $11 |
| Sublingual allergen immunotherapy CPT 95199 • Allergy | $0 | $0 | $0 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $4 | $328 | $732 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $4 | $415 | $732 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $4 | $328 | $732 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $4 | $224 | $488 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $4 | $380 | $854 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $4 | $535 | $1,098 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $4 | $420 | $854 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $4 | $415 | $732 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $4 | $694 | $1,098 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $4 | $477 | $976 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $4 | $362 | $732 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $4 | $508 | $1,000 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $4 | $456 | $900 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $483 | $12,468 | $35,896 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $851 | $20,335 | $58,981 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $287 | $1,683 | $2,344 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $379 | $1,846 | $2,519 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $1,708 | $2,838 | $5,831 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $509 | $4,178 | $11,414 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $566 | $4,220 | $11,414 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $15 | $26 | $42 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $7 | $11 | $18 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $7 | $9 | $11 |
| Cardiovascular stress test CPT 93015 • Cardiology | $68 | $88 | $112 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $33 | $48 | $68 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $72 | $99 | $169 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $105 | $179 | $277 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $135 | $200 | $231 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $193 | $208 | $247 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $113 | $211 | $328 |
| Stress echocardiography CPT 93350 • Cardiology | $60 | $154 | $212 |
| Left and right heart catheterization CPT 93452 • Cardiology | $481 | $3,663 | $9,610 |
| Left heart catheterization CPT 93458 • Cardiology | $589 | $4,030 | $9,610 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $645 | $3,861 | $9,610 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $28 | $161 | $238 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $12 | $71 | $103 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $132 | $194 | $267 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $132 | $180 | $231 |
| Unlisted dental procedure CPT 41899 • Dental | $824 | $824 | $824 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $12 | $297 | $824 |