| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $4 | $4 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $5 | $6 | $6 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $5 | $8 |
| Allergy testing insect venoms CPT 95017 • Allergy | $4 | $7 | $9 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $7 | $14 | $20 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $8 | $8 | $9 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $14 | $14 | $14 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $12 | $24 | $35 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $7 | $10 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $50 | $51 | $51 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $50 | $212 | $536 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $51 | $294 | $536 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $50 | $51 | $51 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $50 | $51 | $51 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $38 | $421 | $804 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $51 | $338 | $625 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $50 | $212 | $536 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $51 | $428 | $804 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $38 | $376 | $715 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $38 | $44 | $50 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $38 | $44 | $50 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $50 | $50 | $51 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $502 | $681 | $861 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,134 | $1,134 | $1,134 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,436 | $3,955 | $5,474 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,054 | $2,303 | $2,800 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,292 | $2,292 | $2,292 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $482 | $513 | $544 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $857 | $857 | $857 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $20 | $30 | $40 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $6 | $11 | $15 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $11 | $12 | $14 |
| Cardiovascular stress test CPT 93015 • Cardiology | $73 | $100 | $128 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $78 | $86 | $94 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $73 | $114 | $156 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $100 | $210 | $265 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $141 | $365 | $589 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $200 | $228 | $255 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $240 | $351 | $413 |
| Stress echocardiography CPT 93350 • Cardiology | $189 | $228 | $266 |
| Left and right heart catheterization CPT 93452 • Cardiology | $671 | $723 | $776 |
| Left heart catheterization CPT 93458 • Cardiology | $735 | $747 | $759 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $360 | $734 | $1,107 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $39 | $44 | $49 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $126 | $140 | $154 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $37 | $182 | $326 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $330 | $370 | $410 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $41 | $53 | $62 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $40 | $53 | $67 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $113 | $120 | $127 |