| Allergen specific IgE each allergen CPT 86003 • Allergy | $4 | $5 | $7 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $8 | $9 | $11 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $6 | $8 |
| Allergy testing insect venoms CPT 95017 • Allergy | $8 | $8 | $8 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $20 | $31 | $42 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $16 | $16 | $16 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $18 | $18 | $18 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $11 | $16 | $21 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $28 | $28 | $28 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $62 | $212 | $362 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $62 | $262 | $362 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $62 | $212 | $362 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $62 | $152 | $241 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $30 | $171 | $422 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $30 | $212 | $543 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $62 | $242 | $422 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $62 | $262 | $362 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $30 | $212 | $543 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $30 | $192 | $483 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $30 | $151 | $362 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $62 | $272 | $483 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $30 | $151 | $362 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $30 | $792 | $1,264 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,905 | $2,068 | $2,230 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $30 | $2,814 | $4,528 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $30 | $3,303 | $5,316 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $5,091 | $5,505 | $5,920 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $1,086 | $1,197 | $1,308 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $1,208 | $1,331 | $1,455 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $34 | $34 | $34 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $16 | $16 | $16 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $17 | $17 | $17 |
| Cardiovascular stress test CPT 93015 • Cardiology | $69 | $128 | $175 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $33 | $61 | $85 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $174 | $179 | $184 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $177 | $253 | $329 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $156 | $307 | $459 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $151 | $321 | $491 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $235 | $440 | $596 |
| Stress echocardiography CPT 93350 • Cardiology | $30 | $291 | $467 |
| Left and right heart catheterization CPT 93452 • Cardiology | $1,715 | $1,757 | $1,799 |
| Left heart catheterization CPT 93458 • Cardiology | $728 | $1,117 | $1,506 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $687 | $1,551 | $2,845 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $81 | $81 | $81 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $140 | $140 | $140 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $80 | $158 | $236 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $70 | $70 | $70 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $30 | $78 | $126 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $149 | $149 | $149 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $202 | $202 | $202 |