| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $3 | $4 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $5 | $5 | $5 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $9 | $10 | $10 |
| Allergy testing insect venoms CPT 95017 • Allergy | $5 | $6 | $6 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $29 | $30 | $32 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $11 | $12 | $13 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $13 | $14 | $15 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $16 | $16 | $17 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $17 | $19 | $21 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $56 | $56 | $56 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $56 | $56 | $56 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $56 | $56 | $56 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $56 | $56 | $56 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $56 | $56 | $56 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $56 | $56 | $56 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $56 | $56 | $56 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $56 | $56 | $56 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $56 | $56 | $56 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $56 | $56 | $56 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $56 | $56 | $56 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $56 | $56 | $56 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $56 | $56 | $56 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $763 | $920 | $1,078 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,316 | $1,596 | $1,876 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,769 | $3,287 | $3,806 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,689 | $3,472 | $4,479 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $3,619 | $4,309 | $4,998 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $717 | $832 | $947 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $796 | $924 | $1,051 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $25 | $27 | $29 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $14 | $14 | $14 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $11 | $13 | $15 |
| Cardiovascular stress test CPT 93015 • Cardiology | $118 | $123 | $129 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $65 | $67 | $69 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $133 | $143 | $153 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $108 | $108 | $108 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $111 | $152 | $193 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $86 | $232 | $379 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $220 | $385 | $514 |
| Stress echocardiography CPT 93350 • Cardiology | $181 | $292 | $402 |
| Left and right heart catheterization CPT 93452 • Cardiology | $441 | $811 | $1,180 |
| Left heart catheterization CPT 93458 • Cardiology | $1,052 | $1,423 | $1,794 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $1,153 | $1,568 | $1,983 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $299 | $318 | $337 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $140 | $144 | $149 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $37 | $207 | $377 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $223 | $265 | $306 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $71 | $71 | $71 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $33 | $33 | $33 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $37 | $87 | $137 |