| Allergen specific IgE each allergen CPT 86003 • Allergy | $4 | $5 | $5 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $6 | $7 | $7 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $6 | $7 | $8 |
| Allergy testing insect venoms CPT 95017 • Allergy | $5 | $8 | $10 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $23 | $24 | $25 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $7 | $9 | $10 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $9 | $10 | $11 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $12 | $12 | $13 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $8 | $16 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $56 | $56 | $56 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $56 | $56 | $56 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $56 | $56 | $56 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $56 | $56 | $56 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $56 | $56 | $56 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $56 | $56 | $56 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $56 | $56 | $56 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $56 | $56 | $56 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $56 | $56 | $56 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $56 | $56 | $56 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $56 | $56 | $56 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $56 | $56 | $56 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $56 | $56 | $56 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $540 | $636 | $684 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $938 | $1,104 | $1,187 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $1,895 | $2,267 | $2,452 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,222 | $2,663 | $2,884 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,475 | $2,968 | $3,215 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $555 | $656 | $707 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $616 | $728 | $784 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $20 | $21 | $21 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $10 | $10 | $11 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $9 | $10 | $11 |
| Cardiovascular stress test CPT 93015 • Cardiology | $92 | $94 | $96 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $48 | $49 | $52 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $104 | $111 | $115 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $160 | $160 | $160 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $68 | $194 | $299 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $235 | $269 | $287 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $194 | $343 | $418 |
| Stress echocardiography CPT 93350 • Cardiology | $79 | $228 | $303 |
| Left and right heart catheterization CPT 93452 • Cardiology | $879 | $1,026 | $1,099 |
| Left heart catheterization CPT 93458 • Cardiology | $410 | $949 | $1,344 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $368 | $1,112 | $1,485 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $31 | $103 | $238 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $111 | $112 | $114 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $290 | $302 | $307 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $234 | $235 | $236 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $21 | $47 | $60 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $30 | $38 | $53 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $37 | $59 | $99 |