| Allergen specific IgE each allergen CPT 86003 • Allergy | $2 | $4 | $6 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $2 | $6 | $9 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $6 | $15 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $7 | $13 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $5 | $19 | $35 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $1 | $6 | $13 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $11 | $14 | $18 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $13 | $16 | $20 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $10 | $23 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $5 | $127 | $282 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $5 | $253 | $564 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $5 | $146 | $344 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $5 | $92 | $188 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $5 | $140 | $329 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $5 | $174 | $423 |
| Anesthesia for upper GI endoscopy CPT 00740 • Anesthesia | $282 | $282 | $282 |
| Anesthesia for lower GI endoscopy CPT 00810 • Anesthesia | $282 | $282 | $282 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $5 | $170 | $402 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $5 | $146 | $344 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $5 | $352 | $918 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $5 | $188 | $459 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $5 | $123 | $282 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $5 | $102 | $306 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $5 | $189 | $611 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $483 | $7,080 | $38,654 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $787 | $8,709 | $46,824 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $1,620 | $2,556 | $4,142 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $483 | $2,572 | $4,142 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $470 | $3,096 | $5,831 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $510 | $3,149 | $15,545 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $520 | $3,159 | $15,545 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $15 | $19 | $28 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $7 | $10 | $18 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $10 | $14 |
| Cardiovascular stress test CPT 93015 • Cardiology | $76 | $96 | $124 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $40 | $51 | $68 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $72 | $109 | $169 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $88 | $255 | $442 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $56 | $154 | $361 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $75 | $192 | $327 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $134 | $262 | $395 |
| Stress echocardiography CPT 93350 • Cardiology | $73 | $162 | $308 |
| Left and right heart catheterization CPT 93452 • Cardiology | $227 | $3,113 | $15,251 |
| Left heart catheterization CPT 93458 • Cardiology | $308 | $3,302 | $15,251 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $349 | $3,311 | $15,251 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $36 | $207 | $313 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $12 | $74 | $136 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $40 | $236 | $393 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $35 | $193 | $307 |
| Paring or cutting benign hyperkeratotic lesion single CPT 11055 • Dermatology | $12 | $211 | $964 |