| Allergen specific IgE each allergen CPT 86003 • Allergy | $4 | $5 | $6 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $7 | $8 | $9 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $13 | $13 | $13 |
| Allergy testing insect venoms CPT 95017 • Allergy | $16 | $16 | $16 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $41 | $41 | $41 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $2 | $2 | $2 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $18 | $18 | $18 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $12 | $16 | $20 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $7 | $7 | $7 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $60 | $78 | $95 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $95 | $95 | $95 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $60 | $78 | $95 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $60 | $78 | $95 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $60 | $78 | $95 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $60 | $78 | $95 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $60 | $78 | $95 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $60 | $72 | $95 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $60 | $78 | $95 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $60 | $78 | $95 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $60 | $78 | $95 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $95 | $95 | $95 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $95 | $95 | $95 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $102 | $626 | $1,149 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $102 | $1,050 | $1,998 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $3,969 | $4,017 | $4,064 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $4,784 | $5,058 | $5,195 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $5,335 | $5,335 | $5,335 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $1,161 | $1,175 | $1,189 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $1,320 | $1,363 | $1,405 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $17 | $25 | $34 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $7 | $12 | $17 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $17 | $17 | $17 |
| Cardiovascular stress test CPT 93015 • Cardiology | $152 | $173 | $193 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $77 | $77 | $77 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $181 | $200 | $219 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $155 | $161 | $164 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $102 | $116 | $131 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $321 | $408 | $495 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $102 | $210 | $279 |
| Stress echocardiography CPT 93350 • Cardiology | $102 | $124 | $146 |
| Left and right heart catheterization CPT 93452 • Cardiology | $1,202 | $1,488 | $1,773 |
| Left heart catheterization CPT 93458 • Cardiology | $1,454 | $1,472 | $1,489 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $1,631 | $2,094 | $2,558 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $81 | $82 | $83 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $177 | $209 | $240 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $281 | $358 | $436 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $71 | $71 | $72 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $33 | $33 | $33 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $116 | $116 | $116 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $83 | $149 | $214 |