| Allergen specific IgE each allergen CPT 86003 • Allergy | $2 | $3 | $4 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $3 | $5 | $6 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $3 | $4 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $7 | $8 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $19 | $20 | $21 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $7 | $7 | $8 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $8 | $9 | $9 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $10 | $10 | $11 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $12 | $13 | $14 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $30 | $37 | $50 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $30 | $53 | $127 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $30 | $95 | $269 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $30 | $55 | $110 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $30 | $72 | $178 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $30 | $89 | $247 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $30 | $80 | $210 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $30 | $57 | $146 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $30 | $85 | $232 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $30 | $74 | $187 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $30 | $71 | $173 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $30 | $72 | $178 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $30 | $34 | $50 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $507 | $515 | $530 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $863 | $897 | $932 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $1,818 | $1,986 | $2,244 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $30 | $1,632 | $2,229 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,377 | $2,432 | $2,486 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $514 | $522 | $539 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $485 | $535 | $600 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $13 | $14 | $17 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $5 | $6 | $8 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $8 | $10 |
| Cardiovascular stress test CPT 93015 • Cardiology | $62 | $66 | $70 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $33 | $33 | $33 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $72 | $77 | $87 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $77 | $176 | $224 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $63 | $134 | $184 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $53 | $116 | $205 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $30 | $148 | $234 |
| Stress echocardiography CPT 93350 • Cardiology | $117 | $161 | $183 |
| Left and right heart catheterization CPT 93452 • Cardiology | $667 | $826 | $905 |
| Left heart catheterization CPT 93458 • Cardiology | $251 | $461 | $1,041 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $285 | $794 | $1,159 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $136 | $162 | $197 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $62 | $67 | $71 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $178 | $208 | $235 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $30 | $127 | $183 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $15 | $19 | $30 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $23 | $62 | $82 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $95 | $97 | $99 |