| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $6 | $11 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $5 | $9 | $18 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $6 | $8 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $8 | $13 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $5 | $23 | $44 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $1 | $5 | $12 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $9 | $14 | $24 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $10 | $17 | $28 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $12 | $25 |
| Sublingual allergen immunotherapy CPT 95199 • Allergy | $0 | $0 | $0 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $4 | $38 | $79 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $4 | $38 | $79 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $4 | $38 | $79 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $5 | $38 | $79 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $5 | $38 | $79 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $5 | $38 | $79 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $4 | $38 | $79 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $4 | $38 | $79 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $4 | $355 | $981 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $4 | $38 | $79 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $5 | $38 | $79 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $4 | $278 | $1,000 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $4 | $520 | $1,967 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $417 | $667 | $1,088 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $618 | $1,167 | $1,915 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $328 | $2,237 | $3,908 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,300 | $3,233 | $4,588 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $361 | $2,855 | $5,095 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $509 | $767 | $1,093 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $568 | $822 | $1,215 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $15 | $21 | $31 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $7 | $11 | $16 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $11 | $17 |
| Cardiovascular stress test CPT 93015 • Cardiology | $88 | $114 | $161 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $44 | $57 | $86 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $72 | $111 | $156 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $100 | $319 | $599 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $200 | $311 | $478 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $81 | $227 | $430 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $158 | $283 | $513 |
| Stress echocardiography CPT 93350 • Cardiology | $60 | $189 | $404 |
| Left and right heart catheterization CPT 93452 • Cardiology | $227 | $665 | $1,287 |
| Left heart catheterization CPT 93458 • Cardiology | $283 | $982 | $1,978 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $321 | $762 | $1,445 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $80 | $174 | $249 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $12 | $68 | $108 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $50 | $198 | $315 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $31 | $121 | $245 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $11 | $50 | $98 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $17 | $54 | $112 |