| Allergen specific IgE each allergen CPT 86003 • Allergy | $10 | $10 | $10 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $15 | $15 | $15 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $2 | $4 | $7 |
| Allergy testing insect venoms CPT 95017 • Allergy | $6 | $6 | $7 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $14 | $24 | $35 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $2 | $2 | $2 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $15 | $15 | $15 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $7 | $12 | $17 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $24 | $25 | $26 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $50 | $79 | $108 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $50 | $53 | $60 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $50 | $79 | $108 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $50 | $79 | $108 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $50 | $79 | $108 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $50 | $55 | $60 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $50 | $79 | $108 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $50 | $53 | $60 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $50 | $79 | $108 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $50 | $79 | $108 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $50 | $79 | $108 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $50 | $79 | $108 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $50 | $53 | $60 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $939 | $939 | $939 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,651 | $1,772 | $1,893 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $3,362 | $3,593 | $3,823 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,130 | $3,040 | $3,951 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $4,406 | $4,711 | $5,016 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $897 | $1,006 | $1,115 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $998 | $998 | $998 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $28 | $28 | $28 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $14 | $14 | $14 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $14 | $14 | $14 |
| Cardiovascular stress test CPT 93015 • Cardiology | $116 | $116 | $116 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $55 | $55 | $55 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $145 | $145 | $145 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $89 | $109 | $129 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $278 | $317 | $355 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $131 | $176 | $220 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $158 | $170 | $182 |
| Stress echocardiography CPT 93350 • Cardiology | $312 | $312 | $312 |
| Left and right heart catheterization CPT 93452 • Cardiology | $1,508 | $1,653 | $1,797 |
| Left heart catheterization CPT 93458 • Cardiology | $637 | $1,203 | $1,770 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $1,362 | $1,362 | $1,362 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $28 | $145 | $263 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $21 | $21 | $21 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $353 | $353 | $353 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $71 | $196 | $321 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $57 | $88 | $110 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $47 | $89 | $130 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $69 | $69 | $69 |