| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $8 | $12 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $5 | $5 | $5 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $11 | $11 | $11 |
| Allergy testing insect venoms CPT 95017 • Allergy | $13 | $13 | $13 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $35 | $35 | $35 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $9 | $9 | $9 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $15 | $15 | $15 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $12 | $12 | $12 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $16 | $16 | $16 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $65 | $222 | $378 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $65 | $274 | $378 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $55 | $217 | $378 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $55 | $154 | $252 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $55 | $248 | $441 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $65 | $316 | $567 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $65 | $253 | $441 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $65 | $274 | $378 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $55 | $311 | $567 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $65 | $285 | $504 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $65 | $222 | $378 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $55 | $280 | $504 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $55 | $270 | $378 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $851 | $1,348 | $1,846 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $60 | $778 | $1,497 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $3,028 | $4,811 | $6,594 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $3,561 | $6,347 | $7,741 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $3,973 | $3,973 | $3,973 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $824 | $843 | $862 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $680 | $798 | $916 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $23 | $26 | $29 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $9 | $9 | $10 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $10 | $12 | $14 |
| Cardiovascular stress test CPT 93015 • Cardiology | $114 | $122 | $130 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $54 | $61 | $67 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $156 | $156 | $156 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $88 | $88 | $88 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $103 | $106 | $109 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $109 | $214 | $319 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $388 | $399 | $421 |
| Stress echocardiography CPT 93350 • Cardiology | $303 | $358 | $412 |
| Left and right heart catheterization CPT 93452 • Cardiology | $1,003 | $1,003 | $1,003 |
| Left heart catheterization CPT 93458 • Cardiology | $463 | $475 | $486 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $1,820 | $1,852 | $1,884 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $45 | $54 | $63 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $129 | $140 | $152 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $44 | $183 | $322 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $55 | $137 | $219 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $18 | $70 | $130 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $39 | $40 | $42 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $44 | $115 | $185 |