| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $4 | $6 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $4 | $7 | $9 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $10 | $10 | $10 |
| Allergy testing insect venoms CPT 95017 • Allergy | $11 | $11 | $11 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $30 | $30 | $30 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $11 | $12 | $13 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $13 | $14 | $15 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $15 | $16 | $17 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $19 | $20 | $21 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $36 | $681 | $1,480 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $52 | $823 | $2,072 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $36 | $522 | $888 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $36 | $376 | $740 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $52 | $579 | $1,036 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $36 | $781 | $1,332 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $36 | $1,002 | $2,220 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $36 | $505 | $814 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $52 | $803 | $1,406 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $36 | $732 | $1,332 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $52 | $628 | $1,406 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $52 | $843 | $1,776 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $36 | $1,397 | $4,500 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $920 | $1,306 | $1,692 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $2,974 | $2,974 | $2,974 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $6,038 | $6,038 | $6,038 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $7,103 | $7,103 | $7,103 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $7,927 | $7,927 | $7,927 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $783 | $783 | $783 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $871 | $961 | $1,051 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $25 | $27 | $29 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $13 | $13 | $14 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $12 | $13 | $15 |
| Cardiovascular stress test CPT 93015 • Cardiology | $112 | $120 | $129 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $58 | $58 | $58 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $135 | $144 | $153 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $115 | $115 | $115 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $93 | $245 | $396 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $337 | $437 | $537 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $202 | $207 | $211 |
| Stress echocardiography CPT 93350 • Cardiology | $124 | $240 | $355 |
| Left and right heart catheterization CPT 93452 • Cardiology | $1,216 | $1,216 | $1,216 |
| Left heart catheterization CPT 93458 • Cardiology | $541 | $1,014 | $1,486 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $1,647 | $1,647 | $1,647 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $58 | $63 | $69 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $18 | $84 | $149 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $57 | $63 | $68 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $60 | $176 | $292 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $21 | $76 | $155 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $189 | $189 | $189 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $157 | $239 | $321 |