| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $3 | $4 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $7 | $7 | $7 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $4 | $5 |
| Allergy testing insect venoms CPT 95017 • Allergy | $9 | $9 | $9 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $20 | $21 | $22 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $1 | $1 | $1 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $10 | $10 | $10 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $11 | $11 | $11 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $2 | $2 | $2 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $52 | $52 | $52 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $34 | $39 | $44 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $52 | $52 | $52 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $52 | $52 | $52 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $44 | $48 | $52 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $44 | $45 | $45 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $52 | $52 | $52 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $44 | $46 | $48 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $30 | $37 | $44 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $40 | $42 | $44 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $44 | $48 | $52 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $52 | $52 | $52 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $44 | $48 | $52 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $623 | $623 | $623 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,198 | $2,198 | $2,198 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,578 | $2,578 | $2,578 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $446 | $446 | $446 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $18 | $18 | $18 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $7 | $7 | $7 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $10 | $10 | $10 |
| Cardiovascular stress test CPT 93015 • Cardiology | $72 | $81 | $90 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $33 | $35 | $37 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $92 | $92 | $92 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $139 | $235 | $331 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $160 | $160 | $160 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $247 | $276 | $304 |
| Stress echocardiography CPT 93350 • Cardiology | $147 | $171 | $196 |
| Left and right heart catheterization CPT 93452 • Cardiology | $269 | $269 | $269 |
| Left heart catheterization CPT 93458 • Cardiology | $1,638 | $1,638 | $1,638 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $992 | $1,093 | $1,193 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $163 | $163 | $163 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $92 | $92 | $92 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $226 | $241 | $256 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $32 | $32 | $32 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $68 | $68 | $68 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $64 | $64 | $64 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $99 | $99 | $99 |
| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $143 | $143 | $143 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $148 | $162 | $177 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $97 | $97 | $97 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $115 | $127 | $139 |