| Allergen specific IgE each allergen CPT 86003 • Allergy | $5 | $5 | $6 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $4 | $5 |
| Allergy testing insect venoms CPT 95017 • Allergy | $4 | $8 | $13 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $8 | $19 | $29 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $5 | $8 | $11 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $14 | $14 | $15 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $18 | $18 | $18 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $4 | $13 | $21 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $40 | $40 | $40 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $30 | $35 | $40 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $40 | $40 | $40 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $30 | $35 | $40 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $40 | $40 | $40 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $30 | $35 | $40 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $30 | $35 | $40 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $40 | $40 | $40 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $30 | $35 | $40 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $30 | $35 | $40 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $30 | $35 | $40 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $40 | $40 | $40 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $40 | $40 | $40 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $545 | $11,431 | $33,016 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $960 | $19,284 | $55,710 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $1,968 | $2,731 | $3,882 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,310 | $2,904 | $3,882 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,568 | $3,033 | $3,882 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $599 | $6,486 | $18,114 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $665 | $6,536 | $18,114 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $18 | $23 | $28 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $9 | $14 | $18 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $11 | $12 | $12 |
| Cardiovascular stress test CPT 93015 • Cardiology | $106 | $109 | $112 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $54 | $61 | $68 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $104 | $137 | $169 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $88 | $230 | $372 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $231 | $275 | $318 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $286 | $287 | $289 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $328 | $336 | $345 |
| Stress echocardiography CPT 93350 • Cardiology | $184 | $227 | $270 |
| Left and right heart catheterization CPT 93452 • Cardiology | $285 | $5,573 | $15,163 |
| Left heart catheterization CPT 93458 • Cardiology | $351 | $5,663 | $15,163 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $395 | $5,715 | $15,163 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $238 | $256 | $274 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $103 | $111 | $118 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $267 | $307 | $346 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $231 | $250 | $270 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $19 | $264 | $697 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $27 | $271 | $697 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $47 | $281 | $697 |
| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $59 | $297 | $697 |