| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $4 | $4 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $5 | $6 | $7 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $7 | $7 | $8 |
| Allergy testing insect venoms CPT 95017 • Allergy | $7 | $10 | $16 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $39 | $40 | $42 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $2 | $5 | $8 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $17 | $17 | $17 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $22 | $22 | $22 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $15 | $22 | $28 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $40 | $55 | $70 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $40 | $40 | $40 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $40 | $40 | $40 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $40 | $40 | $40 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $40 | $55 | $70 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $40 | $40 | $40 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $40 | $48 | $55 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $40 | $45 | $55 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $40 | $55 | $70 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $40 | $55 | $70 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $40 | $48 | $55 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $40 | $40 | $40 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $40 | $45 | $55 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $1,042 | $1,042 | $1,042 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $2,100 | $2,100 | $2,100 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $4,260 | $4,260 | $4,260 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,608 | $3,810 | $5,013 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $5,595 | $5,595 | $5,595 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $1,242 | $1,242 | $1,242 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $1,377 | $1,377 | $1,377 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $27 | $33 | $38 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $11 | $15 | $18 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $15 | $17 | $20 |
| Cardiovascular stress test CPT 93015 • Cardiology | $132 | $152 | $172 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $33 | $49 | $64 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $145 | $174 | $204 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $204 | $248 | $337 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $311 | $384 | $457 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $149 | $264 | $380 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $261 | $363 | $464 |
| Stress echocardiography CPT 93350 • Cardiology | $360 | $367 | $375 |
| Left and right heart catheterization CPT 93452 • Cardiology | $1,776 | $1,776 | $1,776 |
| Left heart catheterization CPT 93458 • Cardiology | $712 | $759 | $805 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $803 | $803 | $803 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $92 | $145 | $198 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $29 | $92 | $156 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $412 | $440 | $467 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $355 | $355 | $355 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $33 | $53 | $74 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $131 | $131 | $131 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $40 | $130 | $220 |