| Allergen specific IgE each allergen CPT 86003 • Allergy | $4 | $4 | $5 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $6 | $6 | $6 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $4 | $4 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $5 | $7 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $18 | $21 | $25 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $5 | $6 | $8 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $10 | $12 | $13 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $13 | $19 | $26 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $7 | $10 | $13 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $37 | $37 | $37 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $37 | $37 | $37 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $37 | $37 | $37 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $37 | $37 | $37 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $37 | $37 | $37 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $37 | $37 | $37 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $37 | $37 | $37 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $37 | $37 | $37 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $37 | $37 | $37 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $37 | $37 | $37 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $37 | $37 | $37 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $37 | $37 | $37 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $37 | $37 | $37 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $735 | $897 | $1,060 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,278 | $1,594 | $1,909 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,734 | $3,124 | $3,513 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $3,136 | $3,947 | $4,758 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $3,438 | $4,110 | $4,783 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $595 | $667 | $739 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $713 | $767 | $821 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $17 | $22 | $34 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $8 | $11 | $14 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $13 | $19 |
| Cardiovascular stress test CPT 93015 • Cardiology | $127 | $133 | $139 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $53 | $66 | $79 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $92 | $137 | $181 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $210 | $288 | $366 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $168 | $177 | $186 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $78 | $161 | $244 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $181 | $197 | $213 |
| Stress echocardiography CPT 93350 • Cardiology | $96 | $101 | $105 |
| Left and right heart catheterization CPT 93452 • Cardiology | $347 | $351 | $354 |
| Left heart catheterization CPT 93458 • Cardiology | $612 | $1,018 | $1,425 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $690 | $1,132 | $1,574 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $28 | $35 | $42 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $80 | $91 | $95 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $59 | $163 | $267 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $76 | $147 | $217 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $22 | $47 | $73 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $21 | $34 | $47 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $99 | $106 | $114 |