| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $6 | $10 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $4 | $7 | $12 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $8 | $15 |
| Allergy testing insect venoms CPT 95017 • Allergy | $4 | $6 | $9 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $7 | $14 | $20 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $1 | $4 | $6 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $8 | $23 | $50 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $12 | $28 | $59 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $6 | $9 |
| Sublingual allergen immunotherapy CPT 95199 • Allergy | $0 | $0 | $0 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $30 | $170 | $362 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $30 | $170 | $362 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $30 | $197 | $362 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $45 | $125 | $241 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $30 | $226 | $422 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $30 | $284 | $543 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $45 | $230 | $422 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $45 | $201 | $362 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $64 | $522 | $981 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $30 | $218 | $483 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $30 | $197 | $362 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $45 | $398 | $1,000 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $64 | $1,025 | $2,324 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $550 | $975 | $1,264 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $618 | $1,470 | $2,230 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $328 | $2,792 | $4,528 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $1,492 | $3,454 | $5,316 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $361 | $3,975 | $5,920 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $509 | $894 | $1,308 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $566 | $994 | $1,455 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $18 | $24 | $33 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $11 | $14 | $18 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $20 | $42 |
| Cardiovascular stress test CPT 93015 • Cardiology | $83 | $190 | $422 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $52 | $68 | $85 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $82 | $217 | $474 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $85 | $139 | $177 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $73 | $472 | $989 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $68 | $394 | $1,013 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $158 | $334 | $596 |
| Stress echocardiography CPT 93350 • Cardiology | $159 | $291 | $467 |
| Left and right heart catheterization CPT 93452 • Cardiology | $481 | $1,322 | $2,301 |
| Left heart catheterization CPT 93458 • Cardiology | $307 | $1,202 | $2,645 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $991 | $1,905 | $2,845 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $32 | $212 | $354 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $92 | $123 | $159 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $31 | $294 | $475 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $148 | $240 | $357 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $11 | $37 | $71 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $25 | $84 | $165 |