| Allergen specific IgE each allergen CPT 86003 • Allergy | $10 | $12 | $14 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $16 | $18 | $21 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $15 | $15 | $16 |
| Allergy testing insect venoms CPT 95017 • Allergy | $29 | $29 | $30 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $71 | $73 | $74 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $28 | $29 | $29 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $28 | $30 | $32 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $37 | $38 | $38 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $50 | $50 | $51 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $105 | $105 | $105 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $61 | $77 | $110 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $61 | $85 | $110 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $61 | $85 | $110 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $61 | $85 | $110 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $61 | $85 | $110 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $61 | $83 | $105 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $61 | $83 | $105 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $61 | $85 | $110 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $61 | $83 | $105 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $61 | $85 | $110 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $61 | $85 | $110 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $61 | $85 | $110 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $1,994 | $2,350 | $2,707 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $3,506 | $4,134 | $4,761 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $7,153 | $8,433 | $9,714 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $8,406 | $9,409 | $11,415 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $9,375 | $11,053 | $12,731 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $2,029 | $2,661 | $3,293 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $2,257 | $2,935 | $3,613 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $61 | $68 | $75 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $32 | $35 | $39 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $29 | $33 | $36 |
| Cardiovascular stress test CPT 93015 • Cardiology | $250 | $329 | $408 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $124 | $163 | $201 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $317 | $417 | $516 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $949 | $1,148 | $1,545 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $605 | $612 | $619 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $565 | $653 | $741 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $391 | $713 | $874 |
| Stress echocardiography CPT 93350 • Cardiology | $677 | $889 | $1,102 |
| Left and right heart catheterization CPT 93452 • Cardiology | $2,471 | $3,958 | $5,444 |
| Left heart catheterization CPT 93458 • Cardiology | $1,109 | $2,518 | $3,928 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $4,274 | $5,615 | $6,956 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $130 | $150 | $170 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $55 | $173 | $290 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $166 | $515 | $864 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $664 | $692 | $720 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $43 | $100 | $205 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $207 | $224 | $241 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $127 | $203 | $280 |