| Allergen specific IgE each allergen CPT 86003 • Allergy | $4 | $6 | $8 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $6 | $10 | $12 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $7 | $15 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $6 | $11 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $6 | $18 | $30 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $1 | $8 | $12 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $12 | $15 | $24 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $14 | $19 | $31 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $10 | $18 |
| Sublingual allergen immunotherapy CPT 95199 • Allergy | $0 | $0 | $0 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $3 | $128 | $391 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $3 | $128 | $391 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $3 | $128 | $391 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $3 | $96 | $261 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $3 | $107 | $304 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $3 | $128 | $391 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $3 | $145 | $457 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $3 | $96 | $261 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $3 | $128 | $391 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $3 | $118 | $348 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $3 | $96 | $261 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $3 | $514 | $1,935 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $3 | $466 | $1,742 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $565 | $774 | $1,183 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $996 | $1,296 | $1,613 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $440 | $1,989 | $2,642 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $481 | $2,327 | $3,108 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,355 | $2,992 | $3,687 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $509 | $648 | $756 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $566 | $696 | $841 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $14 | $26 | $44 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $8 | $14 | $28 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $9 | $12 | $16 |
| Cardiovascular stress test CPT 93015 • Cardiology | $88 | $115 | $174 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $47 | $63 | $104 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $84 | $145 | $260 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $91 | $196 | $324 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $219 | $239 | $260 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $75 | $187 | $308 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $193 | $263 | $389 |
| Stress echocardiography CPT 93350 • Cardiology | $70 | $158 | $208 |
| Left and right heart catheterization CPT 93452 • Cardiology | $266 | $677 | $1,152 |
| Left heart catheterization CPT 93458 • Cardiology | $332 | $722 | $1,144 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $384 | $810 | $1,562 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $36 | $121 | $225 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $74 | $94 | $103 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $51 | $202 | $303 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $51 | $174 | $260 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $14 | $54 | $98 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $20 | $65 | $112 |