| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $4 | $6 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $5 | $8 | $14 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $4 | $4 |
| Allergy testing insect venoms CPT 95017 • Allergy | $4 | $8 | $11 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $7 | $10 | $16 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $5 | $6 | $8 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $7 | $10 | $14 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $8 | $12 | $18 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $4 | $8 | $13 |
| Sublingual allergen immunotherapy CPT 95199 • Allergy | $0 | $0 | $0 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $40 | $249 | $407 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $40 | $230 | $611 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $40 | $230 | $611 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $40 | $162 | $407 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $40 | $264 | $713 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $40 | $230 | $611 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $40 | $264 | $713 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $40 | $162 | $407 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $35 | $331 | $917 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $40 | $298 | $815 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $40 | $230 | $611 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $40 | $527 | $1,500 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $40 | $477 | $1,350 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $536 | $698 | $826 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $152 | $833 | $1,181 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,344 | $2,570 | $2,989 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $1,448 | $2,252 | $2,790 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,467 | $2,957 | $3,755 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $496 | $535 | $599 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $552 | $594 | $665 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $15 | $20 | $28 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $4 | $11 | $18 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $10 | $11 |
| Cardiovascular stress test CPT 93015 • Cardiology | $56 | $84 | $112 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $26 | $46 | $68 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $59 | $104 | $169 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $88 | $118 | $156 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $135 | $181 | $231 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $158 | $214 | $289 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $158 | $226 | $328 |
| Stress echocardiography CPT 93350 • Cardiology | $62 | $132 | $184 |
| Left and right heart catheterization CPT 93452 • Cardiology | $250 | $424 | $737 |
| Left heart catheterization CPT 93458 • Cardiology | $351 | $799 | $1,151 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $395 | $651 | $913 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $28 | $147 | $238 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $74 | $90 | $103 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $31 | $173 | $267 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $132 | $178 | $231 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $19 | $46 | $70 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $25 | $30 | $38 |