| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $6 | $6 | $6 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $5 | $6 |
| Allergy testing insect venoms CPT 95017 • Allergy | $4 | $7 | $10 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $24 | $24 | $24 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $1 | $6 | $11 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $12 | $12 | $12 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $17 | $17 | $17 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $18 | $19 | $19 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $42 | $269 | $496 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $42 | $279 | $752 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $42 | $292 | $542 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $42 | $176 | $310 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $42 | $188 | $333 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $42 | $729 | $1,416 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $42 | $177 | $312 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $42 | $161 | $400 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $42 | $310 | $578 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $42 | $378 | $714 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $42 | $314 | $587 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $42 | $276 | $510 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $42 | $271 | $730 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,243 | $1,243 | $1,243 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $2,580 | $2,580 | $2,580 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,915 | $3,393 | $3,872 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $817 | $817 | $817 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $16 | $19 | $22 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $14 | $15 | $16 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $10 | $11 | $12 |
| Cardiovascular stress test CPT 93015 • Cardiology | $119 | $119 | $120 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $40 | $42 | $43 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $88 | $88 | $88 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $132 | $132 | $133 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $73 | $192 | $311 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $234 | $256 | $278 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $124 | $231 | $284 |
| Stress echocardiography CPT 93350 • Cardiology | $156 | $189 | $223 |
| Left and right heart catheterization CPT 93452 • Cardiology | $826 | $826 | $826 |
| Left heart catheterization CPT 93458 • Cardiology | $403 | $403 | $403 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $465 | $912 | $1,359 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $265 | $265 | $265 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $96 | $103 | $110 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $287 | $309 | $330 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $48 | $115 | $183 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $75 | $75 | $75 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $22 | $22 | $22 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $105 | $118 | $132 |
| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $130 | $149 | $169 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $162 | $162 | $162 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $67 | $93 | $106 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $126 | $145 | $163 |