| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $3 | $3 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $2 | $3 | $4 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $5 | $5 |
| Allergy testing insect venoms CPT 95017 • Allergy | $7 | $9 | $10 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $17 | $20 | $24 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $1 | $3 | $6 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $9 | $9 | $9 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $11 | $11 | $11 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $2 | $9 | $15 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $33 | $43 | $52 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $34 | $40 | $52 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $33 | $43 | $52 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $33 | $43 | $52 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $33 | $43 | $52 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $33 | $43 | $52 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $33 | $43 | $52 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $33 | $40 | $52 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $33 | $43 | $52 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $33 | $43 | $52 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $33 | $43 | $52 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $33 | $43 | $52 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $33 | $40 | $52 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $500 | $536 | $573 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $875 | $933 | $991 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $1,926 | $1,970 | $2,013 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,258 | $2,306 | $2,331 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,503 | $2,503 | $2,503 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $415 | $415 | $415 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $498 | $498 | $498 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $20 | $21 | $22 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $6 | $10 | $13 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $7 | $8 | $9 |
| Cardiovascular stress test CPT 93015 • Cardiology | $96 | $102 | $109 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $54 | $54 | $54 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $132 | $147 | $161 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $86 | $160 | $309 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $240 | $241 | $242 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $216 | $256 | $296 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $149 | $288 | $358 |
| Stress echocardiography CPT 93350 • Cardiology | $72 | $152 | $232 |
| Left and right heart catheterization CPT 93452 • Cardiology | $249 | $249 | $249 |
| Left heart catheterization CPT 93458 • Cardiology | $309 | $567 | $824 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $845 | $1,056 | $1,268 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $164 | $164 | $164 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $10 | $76 | $142 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $31 | $123 | $215 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $133 | $133 | $133 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $8 | $18 | $38 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $49 | $49 | $49 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $57 | $57 | $57 |