| Allergen specific IgE each allergen CPT 86003 • Allergy | $9 | $16 | $20 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $6 | $20 | $30 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $7 | $11 | $15 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $5 | $6 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $12 | $12 | $12 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $8 | $10 | $13 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $9 | $12 | $15 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $17 | $17 | $17 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $21 | $22 | $23 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $32 | $135 | $300 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $74 | $245 | $360 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $32 | $135 | $300 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $32 | $102 | $200 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $32 | $152 | $350 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $32 | $185 | $450 |
| Anesthesia for upper GI endoscopy CPT 00740 • Anesthesia | $300 | $300 | $300 |
| Anesthesia for lower GI endoscopy CPT 00810 • Anesthesia | $300 | $300 | $300 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $32 | $152 | $350 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $32 | $135 | $300 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $74 | $403 | $684 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $32 | $169 | $400 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $32 | $135 | $300 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $32 | $53 | $74 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $74 | $361 | $650 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $859 | $4,724 | $12,077 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,396 | $9,205 | $24,706 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,726 | $3,717 | $5,358 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $3,353 | $4,107 | $5,358 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $4,026 | $5,072 | $5,831 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $528 | $3,979 | $10,532 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $850 | $4,120 | $10,532 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $27 | $35 | $42 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $13 | $13 | $14 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $14 | $22 | $30 |
| Cardiovascular stress test CPT 93015 • Cardiology | $115 | $117 | $120 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $55 | $57 | $60 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $142 | $143 | $143 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $123 | $150 | $177 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $275 | $293 | $310 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $214 | $247 | $281 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $219 | $279 | $339 |
| Stress echocardiography CPT 93350 • Cardiology | $187 | $226 | $265 |
| Left and right heart catheterization CPT 93452 • Cardiology | $1,006 | $3,635 | $8,618 |
| Left heart catheterization CPT 93458 • Cardiology | $1,185 | $4,039 | $8,618 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $1,285 | $3,813 | $8,618 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $259 | $340 | $423 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $99 | $109 | $118 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $338 | $380 | $423 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $258 | $261 | $264 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $91 | $504 | $1,320 |