| Allergen specific IgE each allergen CPT 86003 • Allergy | $4 | $4 | $4 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $3 | $4 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $16 | $18 | $20 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $6 | $7 | $8 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $8 | $8 | $8 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $10 | $10 | $10 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $11 | $13 | $15 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $20 | $20 | $20 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $20 | $69 | $117 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $20 | $215 | $409 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $20 | $53 | $86 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $20 | $53 | $85 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $20 | $222 | $424 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $48 | $210 | $373 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $20 | $67 | $114 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $143 | $476 | $810 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $48 | $109 | $170 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $48 | $195 | $342 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $20 | $74 | $128 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $20 | $355 | $691 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $441 | $441 | $441 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $772 | $772 | $772 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $279 | $1,629 | $2,979 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $3,497 | $3,497 | $3,497 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $5,192 | $5,192 | $5,192 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $1,129 | $1,129 | $1,129 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $440 | $558 | $677 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $12 | $13 | $14 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $7 | $7 | $8 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $9 | $10 |
| Cardiovascular stress test CPT 93015 • Cardiology | $78 | $82 | $87 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $66 | $71 | $76 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $103 | $127 | $150 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $237 | $237 | $237 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $141 | $166 | $192 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $111 | $183 | $255 |
| Stress echocardiography CPT 93350 • Cardiology | $198 | $198 | $198 |
| Left heart catheterization CPT 93458 • Cardiology | $242 | $657 | $1,071 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $275 | $713 | $1,151 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $28 | $116 | $203 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $55 | $72 | $90 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $159 | $208 | $256 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $174 | $186 | $198 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $70 | $71 | $72 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $70 | $76 | $83 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $97 | $102 | $107 |
| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $118 | $126 | $134 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $145 | $153 | $161 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $106 | $106 | $106 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $129 | $129 | $129 |