| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $5 | $6 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $7 | $9 | $11 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $6 | $8 |
| Allergy testing insect venoms CPT 95017 • Allergy | $4 | $7 | $10 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $8 | $16 | $26 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $5 | $10 | $16 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $9 | $15 | $21 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $13 | $17 | $25 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $7 | $15 | $25 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $40 | $279 | $407 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $40 | $292 | $407 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $40 | $308 | $611 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $40 | $217 | $297 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $40 | $403 | $713 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $40 | $455 | $611 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $40 | $375 | $528 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $40 | $279 | $407 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $40 | $535 | $917 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $40 | $492 | $815 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $40 | $401 | $611 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $40 | $787 | $2,234 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $40 | $895 | $2,923 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $731 | $6,645 | $23,952 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $293 | $9,364 | $34,492 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $30 | $2,091 | $5,919 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $397 | $3,803 | $6,628 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $687 | $3,303 | $5,919 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $599 | $3,938 | $16,631 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $665 | $4,814 | $16,631 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $15 | $23 | $29 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $10 | $14 | $22 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $12 | $16 |
| Cardiovascular stress test CPT 93015 • Cardiology | $96 | $118 | $148 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $48 | $65 | $77 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $114 | $143 | $169 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $88 | $265 | $529 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $231 | $326 | $449 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $88 | $266 | $402 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $154 | $270 | $384 |
| Stress echocardiography CPT 93350 • Cardiology | $100 | $207 | $301 |
| Left and right heart catheterization CPT 93452 • Cardiology | $285 | $4,167 | $14,813 |
| Left heart catheterization CPT 93458 • Cardiology | $351 | $3,800 | $14,813 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $395 | $4,737 | $14,813 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $39 | $207 | $313 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $14 | $93 | $145 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $46 | $242 | $417 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $40 | $222 | $383 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $19 | $195 | $682 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $27 | $208 | $682 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $47 | $200 | $682 |