| Allergen specific IgE each allergen CPT 86003 • Allergy | $4 | $5 | $7 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $3 | $5 | $6 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $5 | $6 |
| Allergy testing insect venoms CPT 95017 • Allergy | $8 | $8 | $9 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $20 | $20 | $20 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $7 | $7 | $7 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $9 | $10 | $11 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $10 | $11 | $13 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $11 | $17 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $30 | $37 | $43 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $30 | $88 | $243 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $30 | $202 | $534 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $30 | $83 | $170 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $30 | $146 | $364 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $30 | $154 | $388 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $30 | $170 | $437 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $30 | $137 | $437 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $30 | $164 | $412 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $30 | $164 | $412 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $30 | $164 | $412 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $30 | $124 | $291 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $30 | $464 | $1,746 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $528 | $629 | $707 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $912 | $1,029 | $1,146 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $317 | $1,587 | $2,543 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,114 | $2,695 | $2,986 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,507 | $2,507 | $2,507 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $512 | $512 | $512 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $569 | $656 | $742 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $14 | $16 | $18 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $6 | $8 | $9 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $9 | $11 |
| Cardiovascular stress test CPT 93015 • Cardiology | $66 | $71 | $74 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $40 | $40 | $40 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $72 | $79 | $87 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $73 | $199 | $261 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $81 | $120 | $158 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $195 | $202 | $215 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $104 | $180 | $240 |
| Stress echocardiography CPT 93350 • Cardiology | $90 | $132 | $186 |
| Left and right heart catheterization CPT 93452 • Cardiology | $227 | $232 | $236 |
| Left heart catheterization CPT 93458 • Cardiology | $284 | $565 | $1,038 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $424 | $886 | $1,117 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $28 | $76 | $151 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $12 | $36 | $81 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $201 | $220 | $239 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $150 | $166 | $193 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $59 | $70 | $76 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $70 | $70 | $70 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $41 | $80 | $102 |