| Allergen specific IgE each allergen CPT 86003 • Allergy | $7 | $9 | $12 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $11 | $11 | $11 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $6 | $7 | $9 |
| Allergy testing insect venoms CPT 95017 • Allergy | $12 | $12 | $12 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $10 | $10 | $10 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $11 | $13 | $16 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $12 | $12 | $12 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $14 | $19 | $24 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $18 | $18 | $18 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $50 | $50 | $50 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $50 | $50 | $50 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $50 | $50 | $50 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $50 | $50 | $50 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $50 | $50 | $50 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $50 | $50 | $50 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $50 | $50 | $50 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $33 | $41 | $50 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $50 | $50 | $50 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $50 | $50 | $50 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $50 | $50 | $50 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $50 | $50 | $50 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $50 | $50 | $50 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $743 | $797 | $850 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,301 | $1,389 | $1,476 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $3,049 | $3,049 | $3,049 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $3,161 | $3,373 | $3,585 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $3,998 | $3,998 | $3,998 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $799 | $799 | $799 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $756 | $821 | $887 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $24 | $26 | $29 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $8 | $11 | $12 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $13 | $14 | $17 |
| Cardiovascular stress test CPT 93015 • Cardiology | $108 | $138 | $151 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $53 | $62 | $75 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $116 | $130 | $145 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $240 | $424 | $516 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $338 | $338 | $338 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $230 | $317 | $397 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $155 | $234 | $375 |
| Stress echocardiography CPT 93350 • Cardiology | $237 | $306 | $375 |
| Left and right heart catheterization CPT 93452 • Cardiology | $866 | $866 | $866 |
| Left heart catheterization CPT 93458 • Cardiology | $458 | $988 | $1,519 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $522 | $522 | $522 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $225 | $335 | $399 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $18 | $119 | $175 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $289 | $331 | $373 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $213 | $274 | $307 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $74 | $74 | $74 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $91 | $91 | $91 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $59 | $107 | $155 |