| Allergen specific IgE each allergen CPT 86003 • Allergy | $7 | $11 | $14 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $11 | $11 | $11 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $5 | $7 | $8 |
| Allergy testing insect venoms CPT 95017 • Allergy | $15 | $15 | $15 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $15 | $27 | $38 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $2 | $7 | $11 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $12 | $18 | $21 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $17 | $22 | $25 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $19 | $25 | $30 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $62 | $361 | $520 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $67 | $346 | $525 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $67 | $396 | $602 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $62 | $231 | $347 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $62 | $365 | $607 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $67 | $754 | $1,416 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $62 | $353 | $607 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $62 | $560 | $1,133 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $67 | $483 | $780 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $67 | $501 | $743 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $62 | $398 | $612 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $67 | $431 | $694 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $62 | $460 | $730 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $1,274 | $2,074 | $2,874 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,243 | $1,688 | $2,107 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,580 | $5,716 | $10,308 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $620 | $3,331 | $5,315 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $4,526 | $5,215 | $5,905 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $1,215 | $1,498 | $1,782 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $803 | $1,059 | $1,352 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $23 | $30 | $39 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $14 | $17 | $20 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $12 | $15 | $19 |
| Cardiovascular stress test CPT 93015 • Cardiology | $96 | $131 | $175 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $44 | $83 | $121 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $289 | $289 | $289 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $535 | $535 | $535 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $311 | $351 | $417 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $102 | $334 | $533 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $158 | $385 | $565 |
| Stress echocardiography CPT 93350 • Cardiology | $97 | $331 | $561 |
| Left and right heart catheterization CPT 93452 • Cardiology | $407 | $901 | $1,394 |
| Left heart catheterization CPT 93458 • Cardiology | $524 | $1,814 | $3,389 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $465 | $1,536 | $2,620 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $70 | $256 | $385 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $110 | $151 | $210 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $330 | $468 | $613 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $254 | $309 | $377 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $126 | $126 | $126 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $141 | $141 | $141 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $134 | $202 | $263 |