| Allergen specific IgE each allergen CPT 86003 • Allergy | $1 | $3 | $6 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $4 | $6 | $9 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $8 | $8 | $8 |
| Allergy testing insect venoms CPT 95017 • Allergy | $7 | $7 | $7 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $38 | $38 | $38 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $14 | $14 | $14 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $16 | $16 | $16 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $19 | $19 | $19 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $26 | $26 | $26 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $50 | $145 | $240 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $50 | $181 | $252 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $104 | $415 | $900 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $50 | $105 | $160 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $50 | $456 | $1,200 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $50 | $263 | $378 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $50 | $610 | $1,500 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $50 | $311 | $700 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $50 | $622 | $1,700 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $104 | $590 | $1,600 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $104 | $199 | $252 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $104 | $641 | $1,500 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $104 | $749 | $2,400 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $913 | $1,079 | $1,245 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,612 | $1,901 | $2,190 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $3,273 | $3,869 | $4,465 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $3,843 | $4,545 | $5,247 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $4,279 | $5,066 | $5,853 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $993 | $993 | $993 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $1,105 | $1,105 | $1,105 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $21 | $26 | $31 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $15 | $15 | $15 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $16 | $16 | $16 |
| Cardiovascular stress test CPT 93015 • Cardiology | $129 | $129 | $129 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $60 | $60 | $60 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $159 | $159 | $159 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $301 | $301 | $301 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $301 | $301 | $301 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $290 | $333 | $376 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $449 | $449 | $449 |
| Stress echocardiography CPT 93350 • Cardiology | $134 | $134 | $134 |
| Left and right heart catheterization CPT 93452 • Cardiology | $444 | $444 | $444 |
| Left heart catheterization CPT 93458 • Cardiology | $1,932 | $1,932 | $1,932 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $2,103 | $2,103 | $2,103 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $57 | $66 | $74 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $152 | $152 | $152 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $236 | $345 | $455 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $64 | $64 | $64 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $28 | $87 | $145 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $40 | $106 | $172 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $66 | $149 | $232 |