| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $7 | $10 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $4 | $8 | $11 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $9 | $15 |
| Allergy testing insect venoms CPT 95017 • Allergy | $4 | $12 | $20 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $7 | $27 | $49 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $2 | $9 | $19 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $9 | $14 | $21 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $10 | $18 | $26 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $16 | $31 |
| Sublingual allergen immunotherapy CPT 95199 • Allergy | $0 | $0 | $0 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $64 | $304 | $600 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $64 | $296 | $606 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $8 | $231 | $600 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $5 | $148 | $400 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $64 | $408 | $763 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $12 | $514 | $1,416 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $9 | $245 | $700 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $64 | $295 | $606 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $64 | $475 | $981 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $7 | $355 | $872 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $5 | $297 | $654 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $64 | $525 | $1,425 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $64 | $702 | $1,368 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $423 | $1,208 | $2,874 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $743 | $2,133 | $4,991 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $1,256 | $4,310 | $10,308 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $1,776 | $5,165 | $12,121 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $401 | $5,836 | $13,514 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $462 | $943 | $1,782 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $513 | $1,011 | $1,978 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $15 | $29 | $42 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $7 | $12 | $19 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $7 | $13 | $21 |
| Cardiovascular stress test CPT 93015 • Cardiology | $75 | $133 | $242 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $37 | $65 | $121 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $59 | $148 | $289 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $113 | $310 | $535 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $51 | $278 | $754 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $85 | $292 | $723 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $134 | $350 | $707 |
| Stress echocardiography CPT 93350 • Cardiology | $62 | $274 | $528 |
| Left and right heart catheterization CPT 93452 • Cardiology | $525 | $1,035 | $1,932 |
| Left heart catheterization CPT 93458 • Cardiology | $307 | $930 | $1,506 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $465 | $1,392 | $3,744 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $47 | $197 | $461 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $15 | $86 | $183 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $46 | $295 | $494 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $40 | $195 | $453 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $19 | $78 | $126 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $27 | $73 | $154 |