| Allergen specific IgE each allergen CPT 86003 • Allergy | $4 | $5 | $6 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $6 | $6 | $6 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $6 | $7 |
| Allergy testing insect venoms CPT 95017 • Allergy | $7 | $8 | $9 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $18 | $21 | $22 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $5 | $7 | $8 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $9 | $11 | $12 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $11 | $13 | $15 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $8 | $13 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $41 | $41 | $41 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $41 | $41 | $41 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $41 | $41 | $41 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $41 | $41 | $41 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $45 | $45 | $45 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $41 | $41 | $41 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $41 | $43 | $45 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $45 | $45 | $45 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $41 | $43 | $45 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $41 | $41 | $41 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $41 | $41 | $41 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $41 | $41 | $41 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $41 | $333 | $518 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $41 | $282 | $763 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $41 | $552 | $1,574 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $41 | $1,527 | $2,126 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $41 | $1,554 | $2,620 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $511 | $521 | $526 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $530 | $545 | $567 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $19 | $20 | $20 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $12 | $12 | $12 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $7 | $8 | $8 |
| Cardiovascular stress test CPT 93015 • Cardiology | $87 | $93 | $95 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $53 | $60 | $63 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $110 | $112 | $115 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $74 | $92 | $144 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $41 | $90 | $184 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $169 | $219 | $245 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $41 | $171 | $337 |
| Stress echocardiography CPT 93350 • Cardiology | $41 | $120 | $219 |
| Left and right heart catheterization CPT 93452 • Cardiology | $547 | $789 | $944 |
| Left heart catheterization CPT 93458 • Cardiology | $857 | $978 | $1,093 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $339 | $939 | $1,298 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $25 | $133 | $196 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $103 | $113 | $119 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $194 | $208 | $236 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $195 | $202 | $212 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $19 | $30 | $41 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $26 | $36 | $41 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $37 | $56 | $92 |
| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $46 | $93 | $116 |