| Allergen specific IgE each allergen CPT 86003 • Allergy | $4 | $6 | $11 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $17 | $17 | $17 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $7 | $8 | $10 |
| Allergy testing insect venoms CPT 95017 • Allergy | $22 | $22 | $22 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $19 | $21 | $21 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $8 | $8 | $8 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $11 | $14 | $21 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $13 | $17 | $27 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $7 | $14 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $47 | $47 | $47 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $41 | $56 | $101 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $41 | $58 | $93 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $41 | $61 | $101 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $101 | $101 | $101 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $47 | $47 | $47 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $41 | $43 | $47 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $41 | $54 | $93 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $41 | $56 | $101 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $93 | $93 | $93 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $41 | $43 | $47 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $41 | $61 | $101 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $41 | $43 | $47 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $41 | $363 | $1,331 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $41 | $1,096 | $2,345 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $41 | $1,670 | $4,772 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $41 | $1,276 | $2,880 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $41 | $1,042 | $3,045 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $478 | $766 | $1,341 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $530 | $852 | $1,495 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $16 | $23 | $37 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $8 | $13 | $24 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $13 | $21 |
| Cardiovascular stress test CPT 93015 • Cardiology | $94 | $108 | $150 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $57 | $66 | $92 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $108 | $134 | $187 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $75 | $225 | $675 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $41 | $200 | $408 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $239 | $288 | $385 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $41 | $185 | $616 |
| Stress echocardiography CPT 93350 • Cardiology | $215 | $236 | $301 |
| Left and right heart catheterization CPT 93452 • Cardiology | $858 | $1,345 | $2,317 |
| Left heart catheterization CPT 93458 • Cardiology | $779 | $1,508 | $2,675 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $1,180 | $1,604 | $2,878 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $28 | $97 | $162 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $116 | $137 | $179 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $189 | $272 | $519 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $162 | $241 | $397 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $18 | $37 | $46 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $26 | $93 | $213 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $36 | $77 | $99 |