| Allergen specific IgE each allergen CPT 86003 • Allergy | $4 | $6 | $7 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $7 | $12 | $18 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $5 | $6 |
| Allergy testing insect venoms CPT 95017 • Allergy | $4 | $6 | $10 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $8 | $15 | $31 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $5 | $10 | $18 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $9 | $14 | $21 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $10 | $17 | $27 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $4 | $10 | $18 |
| Sublingual allergen immunotherapy CPT 95199 • Allergy | $0 | $0 | $0 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $40 | $559 | $899 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $40 | $473 | $899 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $40 | $501 | $899 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $40 | $246 | $469 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $40 | $550 | $1,049 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $40 | $527 | $1,044 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $40 | $556 | $1,049 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $40 | $477 | $899 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $30 | $321 | $804 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $40 | $538 | $928 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $40 | $482 | $899 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $40 | $627 | $1,290 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $32 | $623 | $1,742 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $536 | $707 | $850 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $28 | $926 | $1,613 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $57 | $1,718 | $2,344 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $67 | $1,284 | $2,519 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $74 | $2,275 | $3,912 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $509 | $585 | $709 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $566 | $641 | $791 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $15 | $21 | $28 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $6 | $10 | $18 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $9 | $11 |
| Cardiovascular stress test CPT 93015 • Cardiology | $2 | $74 | $115 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $33 | $53 | $68 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $2 | $86 | $169 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $9 | $122 | $298 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $85 | $197 | $247 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $64 | $176 | $289 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $7 | $171 | $371 |
| Stress echocardiography CPT 93350 • Cardiology | $95 | $160 | $207 |
| Left and right heart catheterization CPT 93452 • Cardiology | $285 | $751 | $1,000 |
| Left heart catheterization CPT 93458 • Cardiology | $306 | $502 | $1,151 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $346 | $532 | $1,120 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $6 | $119 | $238 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $3 | $53 | $103 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $8 | $140 | $267 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $6 | $102 | $231 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $15 | $26 | $45 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $27 | $55 | $83 |