| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $8 | $13 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $5 | $12 | $20 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $6 | $6 | $7 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $5 | $7 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $13 | $16 | $18 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $6 | $6 | $7 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $15 | $15 | $15 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $9 | $9 | $9 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $2 | $8 | $14 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $42 | $75 | $108 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $108 | $229 | $292 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $52 | $172 | $292 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $42 | $75 | $108 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $42 | $161 | $341 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $108 | $326 | $438 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $42 | $75 | $108 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $52 | $211 | $292 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $52 | $309 | $438 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $100 | $291 | $389 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $42 | $147 | $292 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $42 | $71 | $100 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $42 | $129 | $292 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $594 | $746 | $856 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,484 | $1,484 | $1,484 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $42 | $1,031 | $2,019 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,460 | $2,817 | $3,531 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,626 | $2,626 | $2,626 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $449 | $449 | $449 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $539 | $552 | $566 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $15 | $26 | $37 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $6 | $7 | $7 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $7 | $7 | $7 |
| Cardiovascular stress test CPT 93015 • Cardiology | $66 | $74 | $82 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $104 | $104 | $104 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $79 | $80 | $80 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $69 | $140 | $280 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $359 | $359 | $359 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $201 | $264 | $328 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $268 | $417 | $513 |
| Stress echocardiography CPT 93350 • Cardiology | $207 | $210 | $212 |
| Left and right heart catheterization CPT 93452 • Cardiology | $264 | $264 | $264 |
| Left heart catheterization CPT 93458 • Cardiology | $287 | $556 | $825 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $373 | $1,038 | $1,669 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $34 | $82 | $129 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $80 | $140 | $199 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $47 | $108 | $169 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $166 | $289 | $412 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $42 | $62 | $74 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $86 | $86 | $86 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $34 | $46 | $58 |