| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $3 | $4 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $5 | $5 | $6 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $5 | $6 |
| Allergy testing insect venoms CPT 95017 • Allergy | $6 | $6 | $6 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $17 | $25 | $33 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $6 | $9 | $12 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $9 | $11 | $14 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $11 | $13 | $16 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $5 | $10 | $15 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $34 | $34 | $34 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $38 | $64 | $89 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $38 | $63 | $88 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $34 | $57 | $79 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $38 | $74 | $109 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $34 | $100 | $167 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $38 | $143 | $248 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $38 | $63 | $88 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $38 | $107 | $177 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $38 | $103 | $168 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $34 | $71 | $108 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $34 | $81 | $128 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $38 | $1,128 | $2,219 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $815 | $815 | $815 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,434 | $1,434 | $1,434 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,915 | $2,915 | $2,915 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $3,428 | $3,428 | $3,428 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $3,825 | $3,825 | $3,825 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $835 | $835 | $835 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $929 | $929 | $929 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $11 | $21 | $26 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $13 | $13 | $13 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $13 | $13 | $13 |
| Cardiovascular stress test CPT 93015 • Cardiology | $62 | $86 | $110 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $51 | $51 | $51 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $59 | $97 | $135 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $243 | $249 | $254 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $258 | $258 | $258 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $142 | $229 | $316 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $91 | $149 | $206 |
| Stress echocardiography CPT 93350 • Cardiology | $113 | $113 | $113 |
| Left and right heart catheterization CPT 93452 • Cardiology | $1,318 | $1,318 | $1,318 |
| Left heart catheterization CPT 93458 • Cardiology | $1,111 | $1,111 | $1,111 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $1,735 | $1,735 | $1,735 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $136 | $221 | $306 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $12 | $45 | $104 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $62 | $164 | $260 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $33 | $170 | $296 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $60 | $73 | $86 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $70 | $86 | $103 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $82 | $116 | $151 |