| Allergen specific IgE each allergen CPT 86003 • Allergy | $2 | $3 | $3 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $5 | $6 | $8 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $6 | $7 | $7 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $6 | $8 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $11 | $17 | $24 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $2 | $5 | $8 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $8 | $8 | $8 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $10 | $14 | $19 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $4 | $9 | $14 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $38 | $47 | $56 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $35 | $124 | $288 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $35 | $48 | $60 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $38 | $47 | $56 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $30 | $141 | $336 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $30 | $172 | $432 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $36 | $186 | $336 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $30 | $118 | $288 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $54 | $181 | $432 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $35 | $160 | $384 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $50 | $131 | $288 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $38 | $47 | $56 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $56 | $135 | $288 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $789 | $893 | $1,083 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $56 | $609 | $1,162 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $1,951 | $1,951 | $1,951 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,371 | $3,110 | $3,553 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,677 | $3,256 | $3,835 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $832 | $832 | $832 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $744 | $744 | $744 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $14 | $18 | $22 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $7 | $9 | $12 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $10 | $11 | $12 |
| Cardiovascular stress test CPT 93015 • Cardiology | $72 | $89 | $105 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $32 | $47 | $62 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $93 | $106 | $118 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $85 | $175 | $321 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $159 | $165 | $172 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $213 | $238 | $264 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $368 | $404 | $469 |
| Stress echocardiography CPT 93350 • Cardiology | $193 | $216 | $239 |
| Left and right heart catheterization CPT 93452 • Cardiology | $349 | $349 | $349 |
| Left heart catheterization CPT 93458 • Cardiology | $1,331 | $1,331 | $1,331 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $1,183 | $1,393 | $1,669 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $57 | $123 | $190 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $124 | $130 | $136 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $206 | $301 | $396 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $163 | $175 | $186 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $64 | $69 | $74 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $56 | $96 | $136 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $214 | $214 | $214 |