| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $4 | $4 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $6 | $7 | $8 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $6 | $11 |
| Allergy testing insect venoms CPT 95017 • Allergy | $8 | $9 | $10 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $20 | $28 | $59 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $2 | $6 | $10 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $29 | $29 | $29 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $11 | $16 | $24 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $8 | $14 | $19 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $30 | $40 | $59 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $59 | $211 | $362 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $30 | $56 | $106 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $30 | $43 | $88 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $30 | $66 | $194 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $30 | $41 | $83 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $30 | $69 | $216 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $30 | $109 | $362 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $30 | $39 | $75 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $30 | $82 | $294 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $30 | $65 | $232 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $109 | $151 | $194 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $30 | $262 | $647 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $30 | $3,177 | $15,048 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,442 | $6,020 | $23,155 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $30 | $2,415 | $4,454 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $1,170 | $3,877 | $6,415 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $1,170 | $3,722 | $5,831 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $515 | $3,367 | $7,386 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $423 | $2,891 | $9,042 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $13 | $26 | $43 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $6 | $9 | $21 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $12 | $22 |
| Cardiovascular stress test CPT 93015 • Cardiology | $66 | $125 | $242 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $33 | $45 | $84 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $247 | $247 | $247 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $76 | $136 | $196 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $61 | $236 | $600 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $69 | $195 | $432 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $30 | $230 | $589 |
| Stress echocardiography CPT 93350 • Cardiology | $30 | $92 | $189 |
| Left and right heart catheterization CPT 93452 • Cardiology | $675 | $3,158 | $7,386 |
| Left heart catheterization CPT 93458 • Cardiology | $256 | $3,187 | $7,386 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $447 | $3,764 | $7,386 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $38 | $216 | $456 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $9 | $50 | $79 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $50 | $251 | $582 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $62 | $187 | $373 |
| Unlisted dental procedure CPT 41899 • Dental | $360 | $360 | $360 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $26 | $996 | $5,282 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $36 | $141 | $360 |