| Allergen specific IgE each allergen CPT 86003 • Allergy | $4 | $6 | $7 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $11 | $11 | $11 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $9 | $15 |
| Allergy testing insect venoms CPT 95017 • Allergy | $9 | $15 | $20 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $20 | $34 | $49 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $2 | $7 | $11 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $12 | $17 | $21 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $11 | $16 | $25 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $8 | $14 | $19 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $52 | $274 | $496 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $60 | $223 | $362 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $57 | $299 | $542 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $40 | $126 | $212 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $30 | $217 | $564 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $30 | $318 | $885 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $60 | $346 | $632 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $57 | $246 | $362 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $30 | $247 | $659 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $30 | $278 | $743 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $30 | $231 | $612 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $40 | $280 | $521 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $30 | $270 | $730 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $30 | $6,061 | $16,026 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $328 | $15,446 | $48,756 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $30 | $2,272 | $10,308 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $41 | $818 | $3,872 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $57 | $3,557 | $13,514 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $1,782 | $2,522 | $4,683 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $328 | $4,560 | $13,682 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $23 | $32 | $41 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $14 | $17 | $19 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $12 | $17 | $21 |
| Cardiovascular stress test CPT 93015 • Cardiology | $69 | $143 | $242 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $33 | $66 | $121 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $289 | $289 | $289 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $75 | $305 | $535 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $87 | $149 | $211 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $130 | $170 | $211 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $124 | $479 | $1,053 |
| Stress echocardiography CPT 93350 • Cardiology | $30 | $238 | $528 |
| Left and right heart catheterization CPT 93452 • Cardiology | $328 | $2,052 | $3,239 |
| Left heart catheterization CPT 93458 • Cardiology | $328 | $1,858 | $3,389 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $465 | $2,043 | $3,744 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $265 | $363 | $461 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $113 | $163 | $214 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $330 | $445 | $594 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $48 | $206 | $364 |
| Unlisted dental procedure CPT 41899 • Dental | $106 | $106 | $106 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $30 | $174 | $350 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $53 | $179 | $350 |