| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $4 | $4 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $5 | $5 | $6 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $5 | $9 |
| Allergy testing insect venoms CPT 95017 • Allergy | $6 | $9 | $15 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $5 | $15 | $27 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $1 | $5 | $10 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $8 | $12 | $16 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $11 | $14 | $20 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $10 | $17 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $60 | $386 | $559 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $30 | $286 | $559 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $60 | $329 | $559 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $55 | $225 | $373 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $60 | $426 | $652 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $50 | $401 | $838 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $60 | $380 | $652 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $55 | $322 | $559 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $55 | $550 | $838 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $50 | $346 | $745 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $60 | $365 | $559 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $55 | $440 | $745 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $60 | $352 | $559 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $454 | $8,185 | $33,279 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $795 | $19,644 | $64,157 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $43 | $2,705 | $7,033 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $1,992 | $4,531 | $8,277 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $3,823 | $6,602 | $9,231 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $504 | $6,750 | $26,826 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $559 | $8,743 | $26,826 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $13 | $21 | $33 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $6 | $12 | $15 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $9 | $10 |
| Cardiovascular stress test CPT 93015 • Cardiology | $67 | $92 | $157 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $5 | $37 | $91 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $66 | $96 | $174 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $104 | $178 | $257 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $46 | $195 | $341 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $112 | $172 | $193 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $99 | $148 | $235 |
| Stress echocardiography CPT 93350 • Cardiology | $66 | $159 | $204 |
| Left and right heart catheterization CPT 93452 • Cardiology | $905 | $5,651 | $16,212 |
| Left heart catheterization CPT 93458 • Cardiology | $278 | $4,126 | $16,212 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $319 | $3,626 | $16,212 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $44 | $100 | $186 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $14 | $82 | $164 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $36 | $183 | $313 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $35 | $130 | $170 |
| Unlisted dental procedure CPT 41899 • Dental | $747 | $747 | $747 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $67 | $225 | $747 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $74 | $214 | $747 |