| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $3 | $3 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $6 | $11 | $16 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $5 | $6 | $8 |
| Allergy testing insect venoms CPT 95017 • Allergy | $6 | $11 | $13 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $31 | $36 | $41 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $8 | $10 | $12 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $17 | $17 | $17 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $14 | $14 | $14 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $5 | $11 | $17 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $48 | $57 | $66 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $42 | $192 | $486 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $42 | $50 | $58 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $42 | $45 | $48 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $48 | $57 | $66 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $42 | $50 | $58 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $58 | $62 | $66 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $58 | $203 | $486 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $48 | $49 | $50 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $48 | $57 | $66 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $48 | $49 | $50 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $42 | $45 | $48 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $48 | $200 | $486 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $374 | $735 | $1,096 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,949 | $1,949 | $1,949 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,597 | $2,597 | $2,597 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $4,634 | $4,715 | $4,850 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $58 | $838 | $1,619 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $804 | $804 | $804 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $763 | $818 | $874 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $24 | $28 | $33 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $9 | $16 | $24 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $11 | $14 |
| Cardiovascular stress test CPT 93015 • Cardiology | $117 | $119 | $121 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $62 | $67 | $73 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $125 | $152 | $179 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $85 | $278 | $438 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $129 | $129 | $129 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $251 | $294 | $336 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $38 | $224 | $411 |
| Stress echocardiography CPT 93350 • Cardiology | $94 | $207 | $320 |
| Left and right heart catheterization CPT 93452 • Cardiology | $1,736 | $1,736 | $1,736 |
| Left heart catheterization CPT 93458 • Cardiology | $474 | $914 | $1,355 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $455 | $1,193 | $1,932 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $44 | $44 | $44 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $136 | $141 | $146 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $43 | $239 | $436 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $202 | $286 | $370 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $38 | $84 | $131 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $47 | $47 | $48 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $209 | $209 | $209 |