| Allergen specific IgE each allergen CPT 86003 • Allergy | $4 | $4 | $4 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $6 | $6 | $6 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $3 | $3 |
| Allergy testing insect venoms CPT 95017 • Allergy | $7 | $7 | $7 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $17 | $17 | $17 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $6 | $6 | $7 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $9 | $9 | $9 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $9 | $9 | $9 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $12 | $12 | $13 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $30 | $30 | $30 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $30 | $50 | $89 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $30 | $59 | $88 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $30 | $124 | $218 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $30 | $69 | $109 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $30 | $103 | $177 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $30 | $94 | $158 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $30 | $56 | $108 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $30 | $104 | $178 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $30 | $89 | $147 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $30 | $69 | $108 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $30 | $79 | $128 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $30 | $760 | $2,219 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $616 | $616 | $616 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $30 | $30 | $30 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,595 | $2,595 | $2,596 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $13 | $13 | $14 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $5 | $5 | $5 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $7 | $7 | $7 |
| Cardiovascular stress test CPT 93015 • Cardiology | $62 | $64 | $65 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $59 | $64 | $68 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $34 | $148 | $243 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $51 | $117 | $183 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $91 | $179 | $222 |
| Stress echocardiography CPT 93350 • Cardiology | $174 | $174 | $174 |
| Left and right heart catheterization CPT 93452 • Cardiology | $861 | $861 | $861 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $1,065 | $1,065 | $1,065 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $136 | $139 | $142 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $59 | $67 | $76 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $171 | $198 | $226 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $25 | $100 | $175 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $60 | $61 | $62 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $70 | $70 | $70 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $32 | $51 | $70 |
| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $88 | $99 | $109 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $135 | $135 | $135 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $4 | $26 | $69 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $84 | $95 | $106 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $80 | $80 | $80 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $129 | $129 | $129 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $73 | $86 | $99 |