| Allergen specific IgE each allergen CPT 86003 • Allergy | $4 | $5 | $7 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $3 | $7 | $11 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $7 | $11 |
| Allergy testing insect venoms CPT 95017 • Allergy | $4 | $8 | $10 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $19 | $19 | $19 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $9 | $15 | $22 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $15 | $16 | $18 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $11 | $19 | $27 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $4 | $10 | $15 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $77 | $220 | $362 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $23 | $153 | $362 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $23 | $50 | $77 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $38 | $54 | $70 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $57 | $240 | $422 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $23 | $50 | $77 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $30 | $44 | $57 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $37 | $146 | $362 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $23 | $30 | $37 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $77 | $280 | $483 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $75 | $219 | $362 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $70 | $276 | $483 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $37 | $254 | $362 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $1,264 | $1,368 | $1,473 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,247 | $1,966 | $2,684 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,611 | $4,033 | $5,455 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $3,003 | $4,911 | $6,415 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $3,448 | $4,684 | $5,920 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $792 | $1,094 | $1,395 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $588 | $646 | $720 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $15 | $21 | $26 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $10 | $13 | $17 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $15 | $22 |
| Cardiovascular stress test CPT 93015 • Cardiology | $175 | $179 | $183 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $53 | $74 | $85 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $184 | $205 | $226 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $117 | $117 | $117 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $85 | $165 | $221 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $96 | $326 | $491 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $150 | $450 | $684 |
| Stress echocardiography CPT 93350 • Cardiology | $297 | $382 | $467 |
| Left and right heart catheterization CPT 93452 • Cardiology | $586 | $1,203 | $1,820 |
| Left heart catheterization CPT 93458 • Cardiology | $394 | $759 | $1,140 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $447 | $1,769 | $2,845 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $39 | $263 | $544 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $16 | $48 | $112 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $32 | $228 | $377 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $99 | $134 | $169 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $31 | $70 | $112 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $34 | $43 | $52 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $45 | $58 | $70 |