| Allergen specific IgE each allergen CPT 86003 • Allergy | $4 | $6 | $7 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $2 | $9 | $16 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $10 | $11 | $11 |
| Allergy testing insect venoms CPT 95017 • Allergy | $25 | $25 | $25 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $58 | $58 | $58 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $13 | $18 | $23 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $15 | $22 | $29 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $17 | $25 | $33 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $17 | $30 | $43 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $98 | $770 | $1,480 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $59 | $293 | $388 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $109 | $450 | $732 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $109 | $296 | $488 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $109 | $457 | $854 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $98 | $581 | $1,098 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $109 | $467 | $854 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $109 | $349 | $732 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $109 | $590 | $1,098 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $109 | $1,039 | $2,414 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $98 | $792 | $1,846 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $37 | $467 | $976 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $98 | $767 | $1,746 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $920 | $1,332 | $1,551 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,146 | $1,882 | $2,618 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $317 | $2,886 | $5,455 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $9,321 | $9,321 | $9,321 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $6,957 | $6,957 | $6,957 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $1,768 | $1,768 | $1,768 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $742 | $1,356 | $1,971 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $21 | $35 | $48 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $10 | $13 | $16 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $11 | $22 | $28 |
| Cardiovascular stress test CPT 93015 • Cardiology | $74 | $171 | $268 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $53 | $93 | $133 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $153 | $262 | $358 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $988 | $988 | $988 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $106 | $361 | $537 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $112 | $463 | $797 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $150 | $634 | $972 |
| Stress echocardiography CPT 93350 • Cardiology | $124 | $209 | $293 |
| Left and right heart catheterization CPT 93452 • Cardiology | $3,391 | $3,391 | $3,391 |
| Left heart catheterization CPT 93458 • Cardiology | $541 | $1,679 | $2,818 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $522 | $602 | $683 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $65 | $284 | $502 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $24 | $86 | $149 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $68 | $430 | $792 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $53 | $82 | $112 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $69 | $79 | $90 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $274 | $274 | $274 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $102 | $193 | $283 |