| Allergen specific IgE each allergen CPT 86003 • Allergy | $5 | $6 | $7 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $8 | $9 | $11 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $10 | $10 | $10 |
| Allergy testing insect venoms CPT 95017 • Allergy | $20 | $20 | $20 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $49 | $49 | $49 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $19 | $19 | $19 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $21 | $21 | $21 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $24 | $24 | $24 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $8 | $8 | $8 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $60 | $211 | $362 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $62 | $262 | $362 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $62 | $212 | $362 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $62 | $152 | $241 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $62 | $242 | $422 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $60 | $302 | $543 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $62 | $242 | $422 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $60 | $261 | $362 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $60 | $302 | $543 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $60 | $271 | $483 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $62 | $212 | $362 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $62 | $272 | $483 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $62 | $262 | $362 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $1,264 | $1,269 | $1,274 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $2,230 | $2,236 | $2,241 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $4,528 | $4,548 | $4,569 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $5,316 | $5,343 | $5,369 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $5,920 | $5,954 | $5,989 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $1,277 | $1,292 | $1,308 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $1,421 | $1,438 | $1,455 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $40 | $40 | $40 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $19 | $19 | $19 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $20 | $20 | $20 |
| Cardiovascular stress test CPT 93015 • Cardiology | $166 | $170 | $175 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $77 | $81 | $85 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $184 | $194 | $205 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $387 | $387 | $387 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $154 | $155 | $156 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $483 | $487 | $491 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $577 | $586 | $596 |
| Stress echocardiography CPT 93350 • Cardiology | $271 | $369 | $467 |
| Left and right heart catheterization CPT 93452 • Cardiology | $571 | $578 | $586 |
| Left heart catheterization CPT 93458 • Cardiology | $1,771 | $2,208 | $2,645 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $2,705 | $2,775 | $2,845 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $365 | $365 | $365 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $165 | $165 | $165 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $585 | $585 | $585 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $450 | $450 | $450 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $40 | $40 | $40 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $176 | $176 | $176 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $95 | $95 | $95 |