| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $7 | $12 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $5 | $5 | $6 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $4 | $4 |
| Allergy testing insect venoms CPT 95017 • Allergy | $4 | $7 | $13 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $7 | $16 | $35 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $5 | $8 | $13 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $9 | $10 | $14 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $10 | $13 | $18 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $4 | $8 | $14 |
| Sublingual allergen immunotherapy CPT 95199 • Allergy | $0 | $0 | $0 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $40 | $243 | $402 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $40 | $303 | $468 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $40 | $303 | $468 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $40 | $167 | $268 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $40 | $244 | $469 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $40 | $370 | $603 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $40 | $291 | $469 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $40 | $211 | $402 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $40 | $574 | $981 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $40 | $331 | $536 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $40 | $211 | $402 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $40 | $692 | $1,500 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $40 | $597 | $1,350 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $357 | $598 | $731 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $600 | $966 | $1,181 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $1,993 | $2,202 | $2,344 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $322 | $1,835 | $2,663 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,648 | $3,241 | $3,755 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $509 | $662 | $877 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $566 | $624 | $665 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $15 | $20 | $28 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $6 | $12 | $18 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $9 | $11 |
| Cardiovascular stress test CPT 93015 • Cardiology | $83 | $103 | $115 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $44 | $55 | $68 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $78 | $110 | $169 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $88 | $140 | $177 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $69 | $178 | $235 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $68 | $189 | $289 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $113 | $232 | $328 |
| Stress echocardiography CPT 93350 • Cardiology | $159 | $215 | $303 |
| Left and right heart catheterization CPT 93452 • Cardiology | $250 | $648 | $1,385 |
| Left heart catheterization CPT 93458 • Cardiology | $307 | $606 | $1,129 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $346 | $663 | $1,215 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $161 | $202 | $238 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $80 | $91 | $103 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $164 | $232 | $267 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $132 | $190 | $231 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $18 | $36 | $71 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $27 | $51 | $88 |