| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $3 | $3 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $3 | $3 | $3 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $5 | $6 |
| Allergy testing insect venoms CPT 95017 • Allergy | $6 | $10 | $15 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $28 | $29 | $30 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $10 | $11 | $11 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $16 | $17 | $18 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $13 | $17 | $21 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $20 | $23 | $25 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $70 | $605 | $873 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $48 | $329 | $873 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $30 | $325 | $873 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $72 | $412 | $582 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $30 | $365 | $1,019 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $48 | $476 | $1,310 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $45 | $55 | $70 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $70 | $605 | $873 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $50 | $477 | $1,310 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $50 | $429 | $1,164 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $45 | $597 | $873 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $45 | $977 | $2,836 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $67 | $1,088 | $2,324 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $543 | $626 | $710 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,334 | $1,475 | $1,616 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $1,970 | $2,290 | $2,611 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,316 | $2,651 | $2,986 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,586 | $2,586 | $2,586 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $561 | $564 | $566 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $573 | $646 | $777 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $16 | $21 | $23 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $6 | $8 | $9 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $11 | $13 | $15 |
| Cardiovascular stress test CPT 93015 • Cardiology | $91 | $102 | $123 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $33 | $54 | $70 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $113 | $165 | $199 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $137 | $137 | $137 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $63 | $140 | $216 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $193 | $259 | $319 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $128 | $318 | $437 |
| Stress echocardiography CPT 93350 • Cardiology | $184 | $274 | $335 |
| Left and right heart catheterization CPT 93452 • Cardiology | $605 | $1,071 | $1,494 |
| Left heart catheterization CPT 93458 • Cardiology | $473 | $670 | $843 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $334 | $846 | $1,608 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $63 | $216 | $308 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $23 | $76 | $140 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $193 | $196 | $197 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $183 | $229 | $302 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $21 | $49 | $76 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $34 | $38 | $43 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $70 | $111 | $164 |