| Allergen specific IgE each allergen CPT 86003 • Allergy | $2 | $4 | $5 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $3 | $6 | $8 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $6 | $8 |
| Allergy testing insect venoms CPT 95017 • Allergy | $16 | $16 | $16 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $24 | $32 | $40 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $2 | $6 | $9 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $12 | $15 | $17 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $15 | $17 | $20 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $15 | $27 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $66 | $66 | $66 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $66 | $66 | $66 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $26 | $46 | $66 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $66 | $66 | $66 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $66 | $66 | $66 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $66 | $66 | $66 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $26 | $46 | $66 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $66 | $66 | $66 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $66 | $66 | $66 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $66 | $66 | $66 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $66 | $66 | $66 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $66 | $66 | $66 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $66 | $66 | $66 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $925 | $962 | $999 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,632 | $1,694 | $1,757 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $3,297 | $3,437 | $3,577 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $3,870 | $4,037 | $4,203 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $4,304 | $4,495 | $4,687 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $1,017 | $1,017 | $1,017 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $1,131 | $1,131 | $1,131 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $19 | $25 | $32 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $8 | $12 | $16 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $11 | $13 | $16 |
| Cardiovascular stress test CPT 93015 • Cardiology | $132 | $132 | $132 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $63 | $67 | $72 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $164 | $164 | $164 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $146 | $146 | $146 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $434 | $434 | $434 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $243 | $315 | $387 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $442 | $448 | $459 |
| Stress echocardiography CPT 93350 • Cardiology | $343 | $348 | $354 |
| Left and right heart catheterization CPT 93452 • Cardiology | $1,710 | $1,710 | $1,710 |
| Left heart catheterization CPT 93458 • Cardiology | $2,007 | $2,007 | $2,007 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $1,544 | $1,544 | $1,544 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $184 | $241 | $298 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $24 | $88 | $153 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $473 | $473 | $473 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $65 | $65 | $65 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $117 | $125 | $134 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $41 | $90 | $139 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $69 | $72 | $74 |