| Allergen specific IgE each allergen CPT 86003 • Allergy | $4 | $5 | $5 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $5 | $7 | $9 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $7 | $11 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $7 | $10 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $19 | $20 | $20 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $3 | $8 | $13 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $9 | $12 | $15 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $11 | $20 | $32 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $13 | $21 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $104 | $704 | $1,480 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $106 | $559 | $962 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $106 | $546 | $888 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $101 | $397 | $740 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $102 | $592 | $1,036 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $102 | $797 | $1,332 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $30 | $340 | $888 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $30 | $442 | $1,110 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $106 | $817 | $1,406 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $101 | $748 | $1,332 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $106 | $771 | $1,924 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $104 | $861 | $1,776 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $106 | $586 | $1,184 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $30 | $509 | $920 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $3,504 | $3,504 | $3,504 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $30 | $3,580 | $7,129 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $30 | $3,512 | $8,370 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $30 | $1,356 | $2,682 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $514 | $1,118 | $1,721 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $1,051 | $1,485 | $1,918 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $13 | $20 | $29 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $5 | $9 | $14 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $11 | $15 |
| Cardiovascular stress test CPT 93015 • Cardiology | $68 | $125 | $235 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $33 | $75 | $117 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $72 | $107 | $153 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $176 | $177 | $177 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $111 | $180 | $249 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $193 | $320 | $537 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $211 | $260 | $359 |
| Stress echocardiography CPT 93350 • Cardiology | $30 | $147 | $253 |
| Left and right heart catheterization CPT 93452 • Cardiology | $653 | $779 | $905 |
| Left heart catheterization CPT 93458 • Cardiology | $541 | $834 | $1,128 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $1,120 | $1,615 | $2,604 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $38 | $195 | $337 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $79 | $107 | $149 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $68 | $274 | $557 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $33 | $204 | $520 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $30 | $34 | $41 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $21 | $115 | $208 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $36 | $97 | $157 |