| Allergen specific IgE each allergen CPT 86003 • Allergy | $4 | $5 | $6 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $6 | $7 | $9 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $4 | $5 |
| Allergy testing insect venoms CPT 95017 • Allergy | $4 | $7 | $8 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $20 | $20 | $21 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $6 | $7 | $8 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $8 | $8 | $9 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $11 | $11 | $11 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $10 | $12 | $14 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $44 | $53 | $61 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $44 | $55 | $61 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $44 | $53 | $61 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $44 | $53 | $61 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $44 | $53 | $61 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $44 | $53 | $61 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $44 | $53 | $61 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $44 | $55 | $61 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $44 | $53 | $61 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $44 | $53 | $61 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $44 | $53 | $61 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $44 | $53 | $61 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $44 | $55 | $61 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $609 | $746 | $883 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $61 | $558 | $1,055 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,143 | $2,143 | $2,143 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,497 | $3,373 | $3,887 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,776 | $2,776 | $2,776 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $679 | $679 | $679 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $754 | $754 | $754 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $22 | $23 | $24 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $10 | $11 | $12 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $10 | $12 | $14 |
| Cardiovascular stress test CPT 93015 • Cardiology | $115 | $119 | $122 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $65 | $65 | $65 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $128 | $131 | $133 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $210 | $328 | $457 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $111 | $137 | $163 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $89 | $216 | $343 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $374 | $401 | $418 |
| Stress echocardiography CPT 93350 • Cardiology | $244 | $285 | $326 |
| Left and right heart catheterization CPT 93452 • Cardiology | $423 | $560 | $698 |
| Left heart catheterization CPT 93458 • Cardiology | $526 | $899 | $1,272 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $956 | $1,473 | $1,990 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $47 | $130 | $212 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $95 | $100 | $106 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $273 | $279 | $284 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $38 | $38 | $38 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $15 | $42 | $64 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $58 | $59 | $61 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $94 | $100 | $106 |