| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $5 | $7 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $5 | $5 | $6 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $7 | $15 |
| Allergy testing insect venoms CPT 95017 • Allergy | $4 | $10 | $14 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $7 | $13 | $27 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $2 | $7 | $12 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $11 | $15 | $23 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $13 | $15 | $18 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $4 | $12 | $22 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $64 | $415 | $1,008 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $64 | $449 | $1,008 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $64 | $415 | $1,008 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $64 | $269 | $672 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $64 | $591 | $1,176 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $64 | $724 | $1,512 |
| Anesthesia for upper GI endoscopy CPT 00740 • Anesthesia | $318 | $318 | $318 |
| Anesthesia for lower GI endoscopy CPT 00810 • Anesthesia | $318 | $318 | $318 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $64 | $552 | $1,176 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $64 | $396 | $1,008 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $30 | $303 | $711 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $64 | $645 | $1,344 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $64 | $449 | $1,008 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $64 | $831 | $1,375 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $64 | $660 | $1,375 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $536 | $810 | $1,237 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,101 | $1,277 | $1,717 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $1,771 | $2,461 | $3,500 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $2,519 | $3,326 | $4,109 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $563 | $2,942 | $5,831 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $544 | $715 | $977 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $605 | $723 | $965 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $18 | $27 | $44 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $11 | $14 | $18 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $11 | $14 | $17 |
| Cardiovascular stress test CPT 93015 • Cardiology | $102 | $130 | $199 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $43 | $59 | $68 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $130 | $176 | $262 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $88 | $139 | $177 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $120 | $200 | $265 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $101 | $182 | $289 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $103 | $358 | $586 |
| Stress echocardiography CPT 93350 • Cardiology | $184 | $292 | $381 |
| Left and right heart catheterization CPT 93452 • Cardiology | $310 | $890 | $1,281 |
| Left heart catheterization CPT 93458 • Cardiology | $381 | $1,039 | $2,315 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $429 | $1,336 | $2,099 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $207 | $233 | $252 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $25 | $78 | $103 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $43 | $219 | $307 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $165 | $206 | $231 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $19 | $79 | $112 |