| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $8 | $12 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $5 | $12 | $19 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $6 | $12 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $7 | $8 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $20 | $41 | $62 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $7 | $9 | $13 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $9 | $11 | $14 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $10 | $11 | $11 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $14 | $24 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $30 | $50 | $70 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $40 | $157 | $360 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $70 | $74 | $79 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $70 | $74 | $79 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $70 | $190 | $420 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $40 | $217 | $540 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $30 | $50 | $70 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $70 | $170 | $360 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $30 | $213 | $540 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $40 | $197 | $480 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $70 | $170 | $360 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $70 | $74 | $79 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $70 | $170 | $360 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $518 | $1,140 | $1,762 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $911 | $911 | $911 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $1,856 | $1,856 | $1,856 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,102 | $3,900 | $7,415 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,433 | $2,433 | $2,433 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $529 | $1,245 | $1,961 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $485 | $536 | $588 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $15 | $18 | $23 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $5 | $8 | $10 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $8 | $8 |
| Cardiovascular stress test CPT 93015 • Cardiology | $62 | $77 | $109 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $30 | $32 | $33 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $85 | $103 | $121 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $100 | $183 | $248 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $64 | $296 | $527 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $149 | $221 | $314 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $129 | $375 | $770 |
| Stress echocardiography CPT 93350 • Cardiology | $112 | $198 | $298 |
| Left and right heart catheterization CPT 93452 • Cardiology | $236 | $1,172 | $2,108 |
| Left heart catheterization CPT 93458 • Cardiology | $251 | $596 | $1,243 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $285 | $1,688 | $3,661 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $142 | $179 | $245 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $62 | $87 | $130 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $39 | $210 | $389 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $34 | $116 | $181 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $12 | $42 | $60 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $71 | $123 | $175 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $70 | $88 | $99 |