| Allergen immunotherapy injection single CPT 95115 • Allergy | $18 | $18 | $18 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $20 | $21 | $23 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $30 | $30 | $30 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $23 | $23 | $23 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $23 | $23 | $23 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $30 | $30 | $30 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $30 | $30 | $30 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $30 | $30 | $30 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $23 | $23 | $23 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $30 | $30 | $30 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $23 | $26 | $30 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $23 | $26 | $30 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $23 | $26 | $30 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $30 | $30 | $30 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $23 | $26 | $30 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $708 | $709 | $710 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,237 | $1,242 | $1,247 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,543 | $2,543 | $2,543 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,986 | $2,994 | $3,003 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $588 | $588 | $588 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $15 | $15 | $15 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $6 | $14 | $21 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $8 | $8 |
| Cardiovascular stress test CPT 93015 • Cardiology | $140 | $140 | $140 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $199 | $199 | $199 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $93 | $195 | $297 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $127 | $162 | $197 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $391 | $391 | $391 |
| Left heart catheterization CPT 93458 • Cardiology | $295 | $666 | $1,038 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $784 | $951 | $1,118 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $42 | $116 | $191 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $81 | $111 | $140 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $39 | $120 | $201 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $47 | $100 | $154 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $31 | $31 | $31 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $24 | $56 | $88 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $109 | $109 | $109 |
| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $135 | $135 | $135 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $61 | $114 | $167 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $37 | $58 | $80 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $50 | $52 | $55 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $138 | $141 | $145 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $168 | $168 | $168 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $132 | $159 | $185 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $75 | $75 | $75 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $59 | $61 | $62 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $2 | $6 | $9 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $182 | $198 | $214 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $72 | $96 | $120 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $224 | $227 | $230 |