| Allergen specific IgE each allergen CPT 86003 • Allergy | $6 | $7 | $7 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $11 | $11 | $11 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $6 | $7 | $9 |
| Allergy testing insect venoms CPT 95017 • Allergy | $5 | $9 | $13 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $10 | $21 | $32 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $12 | $12 | $12 |
| 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 | $5 | $13 | $22 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $345 | $474 | $603 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $345 | $474 | $603 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $345 | $474 | $603 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $230 | $350 | $469 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $403 | $536 | $670 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $518 | $661 | $804 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $403 | $536 | $670 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $345 | $474 | $603 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $518 | $661 | $804 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $460 | $599 | $737 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $345 | $474 | $603 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $460 | $599 | $737 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $345 | $474 | $603 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $712 | $816 | $920 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $28 | $825 | $1,622 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $57 | $2,516 | $4,974 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $67 | $1,974 | $3,882 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $74 | $74 | $74 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $709 | $709 | $709 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $791 | $854 | $917 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $21 | $23 | $26 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $9 | $11 | $12 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $11 | $12 | $13 |
| Cardiovascular stress test CPT 93015 • Cardiology | $2 | $55 | $108 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $52 | $52 | $52 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $2 | $67 | $133 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $9 | $9 | $9 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $58 | $71 | $85 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $95 | $330 | $564 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $7 | $191 | $375 |
| Stress echocardiography CPT 93350 • Cardiology | $95 | $95 | $95 |
| Left and right heart catheterization CPT 93452 • Cardiology | $988 | $988 | $988 |
| Left heart catheterization CPT 93458 • Cardiology | $396 | $1,000 | $1,605 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $449 | $1,098 | $1,748 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $6 | $152 | $298 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $3 | $65 | $126 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $8 | $193 | $378 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $6 | $148 | $291 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $22 | $61 | $99 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $30 | $73 | $115 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $53 | $102 | $151 |