| Allergen specific IgE each allergen CPT 86003 • Allergy | $2 | $6 | $7 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $3 | $3 | $3 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $5 | $8 | $8 |
| Allergy testing insect venoms CPT 95017 • Allergy | $4 | $13 | $20 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $35 | $39 | $49 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $14 | $16 | $19 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $9 | $16 | $20 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $10 | $16 | $24 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $18 | $27 | $33 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $72 | $331 | $460 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $71 | $513 | $1,008 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $72 | $331 | $460 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $71 | $228 | $307 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $72 | $382 | $537 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $72 | $449 | $691 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $72 | $382 | $537 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $71 | $482 | $1,008 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $71 | $484 | $691 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $72 | $433 | $614 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $71 | $331 | $460 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $72 | $433 | $614 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $71 | $373 | $501 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $686 | $6,099 | $16,026 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,200 | $16,964 | $43,926 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $57 | $1,252 | $2,605 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $57 | $1,908 | $3,047 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $57 | $1,807 | $3,461 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $591 | $1,083 | $2,036 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $665 | $1,122 | $2,036 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $23 | $25 | $27 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $11 | $13 | $15 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $9 | $12 | $13 |
| Cardiovascular stress test CPT 93015 • Cardiology | $73 | $112 | $132 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $34 | $41 | $45 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $88 | $121 | $137 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $166 | $445 | $538 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $274 | $409 | $543 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $207 | $310 | $361 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $432 | $513 | $707 |
| Stress echocardiography CPT 93350 • Cardiology | $143 | $274 | $339 |
| Left and right heart catheterization CPT 93452 • Cardiology | $799 | $1,391 | $1,760 |
| Left heart catheterization CPT 93458 • Cardiology | $1,228 | $1,613 | $1,850 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $1,760 | $1,909 | $1,984 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $76 | $204 | $355 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $17 | $111 | $157 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $260 | $386 | $449 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $39 | $115 | $257 |
| Unlisted dental procedure CPT 41899 • Dental | $110 | $110 | $110 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $23 | $90 | $131 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $32 | $87 | $150 |