| Allergen specific IgE each allergen CPT 86003 • Allergy | $4 | $4 | $4 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $6 | $6 | $6 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $4 | $5 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $5 | $6 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $15 | $15 | $15 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $8 | $9 | $11 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $10 | $11 | $12 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $14 | $14 | $14 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $11 | $15 | $19 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $48 | $274 | $500 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $42 | $112 | $248 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $40 | $321 | $602 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $48 | $143 | $238 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $48 | $191 | $333 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $48 | $272 | $496 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $48 | $279 | $510 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $40 | $161 | $400 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $45 | $323 | $602 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $45 | $300 | $555 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $48 | $322 | $595 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $48 | $290 | $531 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $45 | $274 | $730 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $564 | $564 | $564 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $994 | $1,118 | $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 | $485 | $1,906 | $2,819 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $817 | $817 | $817 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $14 | $18 | $22 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $6 | $10 | $14 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $10 | $12 |
| Cardiovascular stress test CPT 93015 • Cardiology | $74 | $97 | $120 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $44 | $44 | $44 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $73 | $73 | $73 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $260 | $276 | $292 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $76 | $193 | $311 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $201 | $240 | $278 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $158 | $210 | $243 |
| Stress echocardiography CPT 93350 • Cardiology | $99 | $144 | $190 |
| Left and right heart catheterization CPT 93452 • Cardiology | $655 | $655 | $655 |
| Left heart catheterization CPT 93458 • Cardiology | $524 | $761 | $999 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $465 | $797 | $1,130 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $265 | $265 | $265 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $75 | $93 | $110 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $221 | $276 | $330 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $145 | $202 | $259 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $54 | $54 | $54 |
| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $132 | $132 | $132 |
| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $67 | $86 | $105 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $130 | $130 | $130 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $67 | $75 | $80 |