| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $7 | $13 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $5 | $7 | $10 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $8 | $12 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $12 | $25 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $5 | $23 | $58 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $1 | $11 | $24 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $9 | $16 | $27 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $10 | $20 | $32 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $19 | $44 |
| Sublingual allergen immunotherapy CPT 95199 • Allergy | $0 | $0 | $0 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $6 | $420 | $1,480 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $6 | $484 | $2,072 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $4 | $347 | $888 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $3 | $266 | $666 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $5 | $504 | $1,079 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $6 | $521 | $1,332 |
| Anesthesia for upper GI endoscopy CPT 00740 • Anesthesia | $240 | $240 | $240 |
| Anesthesia for lower GI endoscopy CPT 00810 • Anesthesia | $240 | $240 | $240 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $4 | $462 | $1,079 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $4 | $383 | $1,110 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $5 | $548 | $1,628 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $5 | $507 | $1,332 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $6 | $377 | $1,036 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $6 | $653 | $1,776 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $6 | $527 | $1,348 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $423 | $944 | $1,988 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $740 | $1,687 | $3,504 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $392 | $3,345 | $7,129 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $1,776 | $4,187 | $8,370 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $1,982 | $4,537 | $9,311 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $462 | $864 | $1,721 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $513 | $956 | $1,918 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $15 | $26 | $40 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $7 | $11 | $17 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $7 | $12 | $23 |
| Cardiovascular stress test CPT 93015 • Cardiology | $75 | $138 | $242 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $38 | $76 | $123 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $73 | $154 | $261 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $156 | $424 | $867 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $83 | $346 | $780 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $65 | $255 | $537 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $105 | $321 | $602 |
| Stress echocardiography CPT 93350 • Cardiology | $89 | $184 | $447 |
| Left and right heart catheterization CPT 93452 • Cardiology | $191 | $1,277 | $3,280 |
| Left heart catheterization CPT 93458 • Cardiology | $425 | $1,482 | $3,432 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $296 | $987 | $2,610 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $52 | $239 | $466 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $12 | $98 | $204 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $31 | $279 | $589 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $27 | $251 | $459 |