| Allergen specific IgE each allergen CPT 86003 • Allergy | $7 | $7 | $7 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $11 | $11 | $11 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $10 | $10 | $10 |
| Allergy testing insect venoms CPT 95017 • Allergy | $13 | $13 | $13 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $11 | $21 | $32 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $12 | $12 | $13 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $14 | $14 | $15 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $16 | $16 | $17 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $20 | $21 | $21 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $40 | $40 | $40 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $40 | $40 | $40 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $40 | $40 | $40 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $40 | $40 | $40 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $40 | $40 | $40 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $40 | $40 | $40 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $40 | $40 | $40 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $40 | $40 | $40 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $40 | $40 | $40 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $40 | $40 | $40 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $40 | $40 | $40 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $40 | $40 | $40 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $40 | $40 | $40 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $1,078 | $1,095 | $1,112 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,876 | $1,904 | $1,932 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $3,806 | $3,898 | $3,991 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $4,479 | $4,586 | $4,692 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $4,998 | $5,115 | $5,232 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $877 | $912 | $947 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $973 | $1,012 | $1,051 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $26 | $27 | $29 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $12 | $13 | $14 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $14 | $14 | $15 |
| Cardiovascular stress test CPT 93015 • Cardiology | $119 | $124 | $129 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $60 | $62 | $65 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $142 | $148 | $153 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $263 | $263 | $263 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $104 | $195 | $286 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $356 | $367 | $379 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $171 | $342 | $514 |
| Stress echocardiography CPT 93350 • Cardiology | $260 | $331 | $402 |
| Left and right heart catheterization CPT 93452 • Cardiology | $441 | $903 | $1,364 |
| Left heart catheterization CPT 93458 • Cardiology | $508 | $881 | $1,253 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $573 | $1,278 | $1,983 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $49 | $216 | $519 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $20 | $184 | $283 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $317 | $554 | $712 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $93 | $273 | $490 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $88 | $88 | $88 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $44 | $44 | $44 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $183 | $183 | $183 |