| Allergen specific IgE each allergen CPT 86003 • Allergy | $2 | $4 | $5 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $3 | $3 | $3 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $4 | $5 |
| Allergy testing insect venoms CPT 95017 • Allergy | $7 | $9 | $12 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $18 | $21 | $28 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $5 | $7 | $11 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $9 | $11 | $14 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $9 | $11 | $17 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $2 | $11 | $20 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $40 | $65 | $89 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $40 | $56 | $89 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $40 | $65 | $89 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $40 | $51 | $61 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $40 | $56 | $89 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $40 | $56 | $89 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $40 | $65 | $89 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $40 | $56 | $89 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $40 | $47 | $61 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $40 | $56 | $89 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $40 | $47 | $61 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $40 | $65 | $89 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $40 | $56 | $89 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $484 | $619 | $755 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $40 | $685 | $1,329 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $1,728 | $2,247 | $2,765 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,029 | $2,639 | $3,249 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $3,611 | $3,611 | $3,611 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $803 | $803 | $803 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $485 | $642 | $893 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $11 | $16 | $21 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $5 | $7 | $9 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $12 | $13 | $13 |
| Cardiovascular stress test CPT 93015 • Cardiology | $76 | $97 | $112 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $43 | $48 | $53 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $102 | $102 | $102 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $64 | $271 | $386 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $109 | $166 | $222 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $180 | $209 | $253 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $168 | $252 | $337 |
| Stress echocardiography CPT 93350 • Cardiology | $164 | $165 | $165 |
| Left and right heart catheterization CPT 93452 • Cardiology | $239 | $752 | $1,265 |
| Left heart catheterization CPT 93458 • Cardiology | $251 | $329 | $442 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $285 | $956 | $1,584 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $56 | $116 | $149 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $106 | $111 | $116 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $149 | $222 | $339 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $29 | $39 | $49 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $17 | $52 | $98 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $113 | $113 | $113 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $76 | $108 | $139 |