| Allergen specific IgE each allergen CPT 86003 • Allergy | $4 | $5 | $6 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $5 | $17 | $34 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $5 | $8 |
| Allergy testing insect venoms CPT 95017 • Allergy | $4 | $6 | $11 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $8 | $17 | $22 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $5 | $7 | $10 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $9 | $13 | $20 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $10 | $14 | $18 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $15 | $25 |
| Sublingual allergen immunotherapy CPT 95199 • Allergy | $0 | $0 | $0 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $52 | $150 | $333 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $52 | $150 | $333 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $52 | $113 | $222 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $52 | $88 | $148 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $52 | $168 | $389 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $52 | $205 | $500 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $52 | $168 | $389 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $52 | $150 | $333 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $64 | $554 | $1,098 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $52 | $137 | $296 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $52 | $150 | $333 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $52 | $372 | $1,000 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $52 | $489 | $1,350 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $357 | $613 | $750 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $157 | $911 | $1,396 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,344 | $2,758 | $3,079 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $331 | $2,068 | $3,353 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $361 | $2,251 | $3,744 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $509 | $655 | $857 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $566 | $728 | $954 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $18 | $28 | $37 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $10 | $15 | $22 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $10 | $12 | $14 |
| Cardiovascular stress test CPT 93015 • Cardiology | $83 | $105 | $120 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $44 | $57 | $68 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $91 | $134 | $169 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $88 | $192 | $331 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $69 | $223 | $369 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $68 | $238 | $356 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $158 | $291 | $387 |
| Stress echocardiography CPT 93350 • Cardiology | $62 | $207 | $375 |
| Left and right heart catheterization CPT 93452 • Cardiology | $310 | $690 | $1,281 |
| Left heart catheterization CPT 93458 • Cardiology | $307 | $731 | $1,505 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $346 | $837 | $1,735 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $32 | $172 | $245 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $80 | $96 | $106 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $50 | $160 | $267 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $44 | $136 | $231 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $19 | $37 | $71 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $27 | $58 | $108 |