| Allergen specific IgE each allergen CPT 86003 • Allergy | $2 | $4 | $5 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $5 | $5 | $5 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $8 | $11 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $10 | $15 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $7 | $21 | $36 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $8 | $11 | $13 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $10 | $12 | $17 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $12 | $14 | $17 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $6 | $14 | $20 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $78 | $217 | $355 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $78 | $263 | $355 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $30 | $193 | $355 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $69 | $153 | $237 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $78 | $246 | $414 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $78 | $305 | $533 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $30 | $222 | $414 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $69 | $260 | $355 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $78 | $305 | $533 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $78 | $276 | $474 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $30 | $193 | $355 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $78 | $276 | $474 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $78 | $263 | $355 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $546 | $546 | $546 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,510 | $1,510 | $1,510 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $3,070 | $3,070 | $3,070 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $3,603 | $3,603 | $3,603 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,563 | $2,563 | $2,563 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $767 | $767 | $767 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $1,024 | $1,024 | $1,024 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $23 | $30 | $34 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $8 | $8 | $9 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $12 | $12 | $13 |
| Cardiovascular stress test CPT 93015 • Cardiology | $72 | $115 | $157 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $87 | $87 | $87 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $108 | $108 | $108 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $127 | $127 | $127 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $90 | $90 | $90 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $54 | $195 | $394 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $139 | $151 | $164 |
| Stress echocardiography CPT 93350 • Cardiology | $105 | $114 | $123 |
| Left and right heart catheterization CPT 93452 • Cardiology | $342 | $342 | $342 |
| Left heart catheterization CPT 93458 • Cardiology | $1,126 | $1,126 | $1,126 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $483 | $483 | $483 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $35 | $73 | $144 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $18 | $102 | $186 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $172 | $204 | $259 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $142 | $171 | $199 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $64 | $77 | $83 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $19 | $79 | $138 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $91 | $131 | $171 |