| Allergen specific IgE each allergen CPT 86003 • Allergy | $4 | $5 | $7 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $6 | $8 | $11 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $7 | $15 |
| Allergy testing insect venoms CPT 95017 • Allergy | $8 | $9 | $10 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $19 | $29 | $49 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $8 | $12 | $19 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $12 | $17 | $21 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $11 | $18 | $25 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $18 | $31 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $30 | $265 | $500 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $30 | $271 | $752 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $30 | $165 | $300 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $30 | $157 | $283 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $30 | $208 | $564 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $30 | $315 | $885 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $30 | $227 | $425 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $30 | $109 | $267 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $30 | $240 | $659 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $30 | $198 | $533 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $30 | $224 | $612 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $30 | $270 | $510 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $30 | $263 | $730 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $30 | $978 | $2,874 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $30 | $2,088 | $4,991 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $30 | $4,306 | $10,308 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $30 | $3,166 | $12,121 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $30 | $6,772 | $13,514 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $1,782 | $1,782 | $1,782 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $803 | $1,390 | $1,978 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $29 | $35 | $41 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $14 | $17 | $19 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $15 | $18 | $21 |
| Cardiovascular stress test CPT 93015 • Cardiology | $68 | $119 | $242 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $33 | $58 | $121 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $72 | $180 | $289 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $177 | $297 | $535 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $61 | $375 | $754 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $130 | $278 | $512 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $30 | $184 | $347 |
| Stress echocardiography CPT 93350 • Cardiology | $30 | $268 | $764 |
| Left and right heart catheterization CPT 93452 • Cardiology | $1,932 | $1,932 | $1,932 |
| Left heart catheterization CPT 93458 • Cardiology | $286 | $1,015 | $2,356 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $465 | $1,321 | $2,580 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $76 | $171 | $265 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $79 | $134 | $214 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $236 | $387 | $594 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $61 | $257 | $453 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $30 | $78 | $126 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $30 | $47 | $63 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $132 | $197 | $263 |