| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $3 | $3 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $5 | $5 | $5 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $7 | $10 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $8 | $13 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $32 | $36 | $41 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $2 | $7 | $13 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $15 | $16 | $17 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $17 | $18 | $20 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $14 | $21 | $28 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $40 | $53 | $66 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $40 | $135 | $300 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $40 | $619 | $1,752 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $40 | $509 | $1,420 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $40 | $571 | $1,606 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $40 | $911 | $2,628 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $40 | $793 | $2,272 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $40 | $430 | $1,314 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $40 | $935 | $2,698 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $40 | $887 | $2,556 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $40 | $651 | $1,846 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $40 | $603 | $1,704 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $40 | $321 | $876 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $674 | $850 | $1,108 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,876 | $1,912 | $1,949 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $3,966 | $3,966 | $3,966 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,102 | $3,140 | $4,661 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $4,998 | $5,099 | $5,199 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $947 | $994 | $1,040 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $782 | $969 | $1,156 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $22 | $30 | $34 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $10 | $16 | $22 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $12 | $15 | $17 |
| Cardiovascular stress test CPT 93015 • Cardiology | $137 | $137 | $138 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $30 | $47 | $63 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $169 | $187 | $206 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $100 | $189 | $329 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $106 | $118 | $129 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $112 | $206 | $256 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $186 | $253 | $343 |
| Stress echocardiography CPT 93350 • Cardiology | $111 | $149 | $192 |
| Left and right heart catheterization CPT 93452 • Cardiology | $1,038 | $1,387 | $1,736 |
| Left heart catheterization CPT 93458 • Cardiology | $460 | $927 | $1,737 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $522 | $1,409 | $2,219 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $65 | $183 | $300 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $19 | $88 | $136 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $398 | $440 | $481 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $53 | $207 | $301 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $54 | $92 | $131 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $155 | $155 | $155 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $80 | $144 | $209 |