| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $4 | $4 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $5 | $6 | $7 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $4 | $5 |
| Allergy testing insect venoms CPT 95017 • Allergy | $4 | $6 | $8 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $22 | $23 | $25 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $6 | $8 | $9 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $7 | $7 | $7 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $10 | $10 | $10 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $3 | $3 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $48 | $48 | $48 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $48 | $49 | $50 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $48 | $351 | $654 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $48 | $51 | $54 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $48 | $48 | $48 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $48 | $515 | $981 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $50 | $407 | $763 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $48 | $251 | $654 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $48 | $515 | $981 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $45 | $50 | $54 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $48 | $49 | $50 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $48 | $51 | $54 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $48 | $48 | $48 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $478 | $655 | $833 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $721 | $1,095 | $1,469 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $1,869 | $1,869 | $1,869 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,164 | $2,979 | $3,497 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,273 | $2,273 | $2,273 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $573 | $573 | $573 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $550 | $550 | $550 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $17 | $19 | $20 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $7 | $9 | $11 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $9 | $10 |
| Cardiovascular stress test CPT 93015 • Cardiology | $74 | $79 | $85 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $26 | $26 | $26 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $94 | $104 | $114 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $98 | $130 | $160 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $60 | $68 | $77 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $184 | $215 | $245 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $223 | $278 | $311 |
| Stress echocardiography CPT 93350 • Cardiology | $79 | $155 | $232 |
| Left and right heart catheterization CPT 93452 • Cardiology | $516 | $729 | $943 |
| Left heart catheterization CPT 93458 • Cardiology | $338 | $826 | $1,315 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $633 | $1,028 | $1,422 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $31 | $39 | $47 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $55 | $78 | $100 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $30 | $166 | $301 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $32 | $103 | $173 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $13 | $32 | $44 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $57 | $57 | $57 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $40 | $40 | $40 |