| Allergen specific IgE each allergen CPT 86003 • Allergy | $4 | $4 | $5 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $5 | $6 | $7 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $5 | $7 |
| Allergy testing insect venoms CPT 95017 • Allergy | $4 | $6 | $9 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $8 | $18 | $24 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $1 | $5 | $8 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $9 | $9 | $9 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $11 | $11 | $12 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $8 | $13 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $37 | $72 | $106 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $37 | $60 | $106 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $37 | $72 | $106 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $37 | $72 | $106 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $37 | $60 | $106 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $37 | $59 | $102 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $37 | $70 | $102 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $37 | $60 | $106 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $37 | $60 | $106 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $37 | $59 | $102 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $37 | $60 | $106 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $37 | $70 | $102 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $37 | $59 | $102 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $37 | $402 | $591 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,006 | $1,006 | $1,006 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,042 | $2,076 | $2,109 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $37 | $1,640 | $2,481 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,682 | $2,682 | $2,682 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $576 | $586 | $596 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $661 | $661 | $661 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $18 | $18 | $18 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $9 | $9 | $9 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $9 | $9 | $9 |
| Cardiovascular stress test CPT 93015 • Cardiology | $78 | $79 | $81 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $37 | $38 | $41 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $96 | $97 | $98 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $80 | $112 | $176 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $180 | $184 | $189 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $69 | $149 | $228 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $37 | $88 | $190 |
| Stress echocardiography CPT 93350 • Cardiology | $37 | $108 | $208 |
| Left and right heart catheterization CPT 93452 • Cardiology | $277 | $277 | $277 |
| Left heart catheterization CPT 93458 • Cardiology | $1,128 | $1,128 | $1,128 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $863 | $1,131 | $1,266 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $212 | $212 | $212 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $13 | $52 | $91 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $230 | $257 | $271 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $207 | $207 | $207 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $18 | $35 | $50 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $62 | $62 | $62 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $43 | $76 | $109 |