| Allergen specific IgE each allergen CPT 86003 • Allergy | $4 | $5 | $7 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $6 | $6 | $6 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $5 | $8 | $15 |
| Allergy testing insect venoms CPT 95017 • Allergy | $8 | $13 | $18 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $7 | $21 | $35 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $6 | $6 | $6 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $9 | $10 | $11 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $10 | $16 | $26 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $10 | $14 | $17 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $54 | $54 | $54 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $54 | $349 | $606 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $54 | $148 | $243 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $54 | $173 | $291 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $54 | $342 | $609 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $54 | $489 | $783 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $54 | $197 | $340 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $54 | $317 | $606 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $54 | $416 | $783 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $54 | $387 | $696 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $54 | $321 | $522 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $54 | $173 | $291 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $54 | $774 | $1,746 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $30 | $389 | $651 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $844 | $995 | $1,146 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $30 | $684 | $1,705 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,000 | $3,611 | $5,223 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,227 | $2,227 | $2,227 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $499 | $499 | $499 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $555 | $648 | $742 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $18 | $19 | $21 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $9 | $10 | $10 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $9 | $11 |
| Cardiovascular stress test CPT 93015 • Cardiology | $74 | $101 | $145 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $33 | $40 | $47 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $94 | $94 | $94 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $144 | $161 | $177 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $81 | $131 | $181 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $93 | $121 | $148 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $102 | $271 | $573 |
| Stress echocardiography CPT 93350 • Cardiology | $30 | $64 | $90 |
| Left and right heart catheterization CPT 93452 • Cardiology | $239 | $239 | $239 |
| Left heart catheterization CPT 93458 • Cardiology | $294 | $334 | $374 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $331 | $876 | $1,873 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $28 | $39 | $50 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $16 | $59 | $103 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $26 | $230 | $433 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $181 | $209 | $237 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $39 | $73 | $110 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $48 | $48 | $48 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $36 | $43 | $50 |