| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $3 | $3 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $4 | $6 | $7 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $5 | $7 |
| Allergy testing insect venoms CPT 95017 • Allergy | $7 | $8 | $9 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $12 | $17 | $23 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $12 | $13 | $14 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $15 | $15 | $15 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $18 | $18 | $18 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $15 | $20 | $24 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $30 | $43 | $56 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $30 | $220 | $575 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $30 | $43 | $56 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $30 | $45 | $60 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $30 | $43 | $56 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $56 | $442 | $829 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $30 | $45 | $60 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $60 | $396 | $575 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $60 | $444 | $829 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $60 | $398 | $737 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $30 | $45 | $60 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $30 | $45 | $60 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $30 | $222 | $575 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $936 | $1,010 | $1,085 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,647 | $1,778 | $1,909 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $3,349 | $3,648 | $3,947 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $30 | $1,332 | $3,935 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $4,389 | $4,389 | $4,389 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $914 | $944 | $973 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $1,017 | $1,050 | $1,083 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $18 | $23 | $29 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $9 | $12 | $14 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $9 | $12 | $14 |
| Cardiovascular stress test CPT 93015 • Cardiology | $120 | $132 | $143 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $57 | $65 | $73 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $141 | $145 | $149 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $80 | $143 | $267 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $109 | $109 | $109 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $125 | $132 | $139 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $30 | $178 | $273 |
| Stress echocardiography CPT 93350 • Cardiology | $30 | $115 | $199 |
| Left and right heart catheterization CPT 93452 • Cardiology | $961 | $1,253 | $1,546 |
| Left heart catheterization CPT 93458 • Cardiology | $337 | $1,075 | $1,814 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $1,974 | $2,072 | $2,170 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $170 | $220 | $269 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $143 | $144 | $146 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $362 | $393 | $425 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $329 | $329 | $329 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $29 | $40 | $62 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $42 | $42 | $42 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $70 | $70 | $70 |