| Allergen specific IgE each allergen CPT 86003 • Allergy | $2 | $5 | $7 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $11 | $13 | $16 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $9 | $9 | $9 |
| Allergy testing insect venoms CPT 95017 • Allergy | $18 | $18 | $18 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $17 | $17 | $17 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $2 | $2 | $2 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $20 | $20 | $20 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $23 | $23 | $23 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $30 | $30 | $30 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $80 | $221 | $362 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $80 | $268 | $362 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $80 | $221 | $362 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $80 | $161 | $241 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $80 | $251 | $422 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $80 | $312 | $543 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $37 | $230 | $422 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $37 | $254 | $362 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $80 | $312 | $543 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $80 | $281 | $483 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $37 | $200 | $362 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $37 | $260 | $483 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $70 | $265 | $362 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $1,264 | $1,280 | $1,296 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $2,230 | $2,256 | $2,282 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,527 | $3,582 | $4,637 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,797 | $4,515 | $5,431 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $3,106 | $4,513 | $5,920 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $656 | $671 | $686 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $730 | $746 | $762 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $16 | $28 | $41 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $18 | $18 | $18 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $9 | $15 | $20 |
| Cardiovascular stress test CPT 93015 • Cardiology | $156 | $165 | $175 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $50 | $67 | $85 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $184 | $188 | $192 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $361 | $361 | $361 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $288 | $420 | $553 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $171 | $331 | $491 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $307 | $567 | $798 |
| Stress echocardiography CPT 93350 • Cardiology | $157 | $312 | $467 |
| Left and right heart catheterization CPT 93452 • Cardiology | $293 | $1,297 | $2,301 |
| Left heart catheterization CPT 93458 • Cardiology | $982 | $1,025 | $1,067 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $413 | $1,629 | $2,845 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $41 | $145 | $249 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $28 | $111 | $193 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $88 | $295 | $502 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $44 | $110 | $177 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $88 | $88 | $88 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $47 | $105 | $164 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $240 | $240 | $240 |