| Allergen specific IgE each allergen CPT 86003 • Allergy | $5 | $6 | $7 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $8 | $9 | $10 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $10 | $12 | $13 |
| Allergy testing insect venoms CPT 95017 • Allergy | $10 | $18 | $26 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $57 | $61 | $65 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $22 | $24 | $25 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $28 | $29 | $29 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $32 | $34 | $35 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $41 | $43 | $44 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $64 | $64 | $64 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $64 | $64 | $64 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $87 | $87 | $87 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $64 | $64 | $64 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $64 | $64 | $64 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $64 | $64 | $64 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $87 | $87 | $87 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $64 | $64 | $64 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $64 | $64 | $64 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $87 | $87 | $87 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $87 | $87 | $87 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $64 | $64 | $64 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $87 | $87 | $87 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $1,389 | $1,511 | $1,632 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $2,446 | $2,658 | $2,871 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $4,986 | $5,415 | $5,844 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $5,854 | $6,360 | $6,867 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $6,504 | $7,081 | $7,659 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $1,400 | $1,531 | $1,662 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $1,558 | $1,703 | $1,848 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $40 | $46 | $52 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $18 | $22 | $26 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $23 | $24 | $26 |
| Cardiovascular stress test CPT 93015 • Cardiology | $204 | $210 | $216 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $102 | $104 | $106 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $204 | $236 | $269 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $238 | $485 | $732 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $171 | $440 | $710 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $224 | $390 | $556 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $336 | $502 | $667 |
| Stress echocardiography CPT 93350 • Cardiology | $525 | $552 | $578 |
| Left and right heart catheterization CPT 93452 • Cardiology | $739 | $1,296 | $1,854 |
| Left heart catheterization CPT 93458 • Cardiology | $2,356 | $2,617 | $2,878 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $3,095 | $3,332 | $3,570 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $122 | $277 | $432 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $39 | $135 | $232 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $679 | $726 | $773 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $91 | $342 | $594 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $192 | $197 | $202 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $72 | $153 | $234 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $104 | $205 | $306 |