| Allergen specific IgE each allergen CPT 86003 • Allergy | $14 | $14 | $14 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $21 | $21 | $21 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $13 | $14 | $15 |
| Allergy testing insect venoms CPT 95017 • Allergy | $11 | $18 | $29 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $60 | $66 | $71 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $24 | $26 | $28 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $27 | $30 | $32 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $31 | $34 | $37 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $9 | $29 | $50 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $110 | $110 | $110 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $61 | $77 | $110 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $61 | $85 | $110 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $61 | $85 | $110 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $61 | $85 | $110 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $61 | $83 | $105 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $61 | $85 | $110 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $61 | $83 | $105 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $61 | $83 | $105 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $61 | $85 | $110 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $61 | $83 | $105 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $61 | $85 | $110 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $61 | $85 | $110 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $1,994 | $3,055 | $4,117 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $3,506 | $5,374 | $7,241 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $7,153 | $10,963 | $14,773 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $8,406 | $11,391 | $17,361 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $9,375 | $14,369 | $19,363 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $2,029 | $2,538 | $3,046 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $2,257 | $2,823 | $3,389 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $61 | $66 | $70 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $32 | $34 | $37 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $29 | $31 | $34 |
| Cardiovascular stress test CPT 93015 • Cardiology | $250 | $316 | $382 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $124 | $156 | $189 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $317 | $401 | $484 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $949 | $1,116 | $1,449 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $218 | $748 | $1,278 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $741 | $936 | $1,131 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $874 | $1,028 | $1,334 |
| Stress echocardiography CPT 93350 • Cardiology | $677 | $855 | $1,033 |
| Left and right heart catheterization CPT 93452 • Cardiology | $1,334 | $1,902 | $2,471 |
| Left heart catheterization CPT 93458 • Cardiology | $1,095 | $3,545 | $5,995 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $4,274 | $5,399 | $6,524 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $130 | $520 | $911 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $52 | $171 | $290 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $864 | $965 | $1,065 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $113 | $525 | $937 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $51 | $238 | $457 |
| Paring or cutting benign hyperkeratotic lesions 2-4 CPT 11056 • Dermatology | $166 | $204 | $241 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $127 | $429 | $731 |