| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $5 | $9 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $5 | $7 | $14 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $4 | $7 |
| Allergy testing insect venoms CPT 95017 • Allergy | $4 | $5 | $7 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $7 | $13 | $20 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $1 | $4 | $6 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $7 | $12 | $21 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $9 | $15 | $25 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $4 | $10 | $15 |
| Sublingual allergen immunotherapy CPT 95199 • Allergy | $0 | $0 | $0 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $30 | $147 | $350 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $30 | $182 | $396 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $30 | $222 | $594 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $30 | $133 | $270 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $30 | $253 | $693 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $30 | $219 | $525 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $30 | $177 | $408 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $30 | $157 | $350 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $30 | $316 | $891 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $30 | $285 | $792 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $30 | $157 | $350 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $30 | $421 | $1,476 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $30 | $372 | $1,348 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $436 | $629 | $906 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $911 | $1,174 | $1,595 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $319 | $1,945 | $3,219 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,182 | $2,739 | $3,778 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,025 | $2,780 | $4,193 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $505 | $608 | $899 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $562 | $722 | $999 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $13 | $21 | $28 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $5 | $11 | $18 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $7 | $10 | $14 |
| Cardiovascular stress test CPT 93015 • Cardiology | $65 | $94 | $140 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $31 | $52 | $77 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $68 | $114 | $169 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $88 | $222 | $537 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $135 | $231 | $423 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $68 | $224 | $378 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $110 | $297 | $448 |
| Stress echocardiography CPT 93350 • Cardiology | $71 | $186 | $355 |
| Left and right heart catheterization CPT 93452 • Cardiology | $285 | $835 | $1,671 |
| Left heart catheterization CPT 93458 • Cardiology | $295 | $974 | $1,933 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $334 | $972 | $2,076 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $32 | $203 | $370 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $13 | $92 | $162 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $31 | $248 | $469 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $165 | $225 | $365 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $11 | $27 | $62 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $23 | $37 | $71 |