| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $5 | $7 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $5 | $8 | $11 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $5 | $9 |
| Allergy testing insect venoms CPT 95017 • Allergy | $4 | $8 | $12 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $6 | $15 | $29 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $5 | $10 | $20 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $8 | $11 | $14 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $9 | $16 | $32 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $4 | $12 | $18 |
| Sublingual allergen immunotherapy CPT 95199 • Allergy | $0 | $0 | $0 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $40 | $89 | $282 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $40 | $89 | $282 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $40 | $89 | $282 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $40 | $70 | $188 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $40 | $98 | $329 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $40 | $117 | $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 | $40 | $98 | $329 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $40 | $89 | $282 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $30 | $115 | $423 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $40 | $112 | $400 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $40 | $89 | $282 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $40 | $232 | $1,000 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $40 | $285 | $900 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $304 | $826 | $1,531 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $834 | $1,337 | $2,261 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $279 | $2,492 | $4,639 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $1,268 | $3,046 | $5,451 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $307 | $2,493 | $3,678 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $433 | $740 | $1,328 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $481 | $662 | $891 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $15 | $25 | $42 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $4 | $13 | $21 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $6 | $12 | $20 |
| Cardiovascular stress test CPT 93015 • Cardiology | $56 | $88 | $112 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $28 | $57 | $101 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $60 | $132 | $232 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $88 | $156 | $241 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $56 | $153 | $245 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $75 | $182 | $289 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $134 | $237 | $328 |
| Stress echocardiography CPT 93350 • Cardiology | $62 | $186 | $344 |
| Left and right heart catheterization CPT 93452 • Cardiology | $285 | $589 | $870 |
| Left heart catheterization CPT 93458 • Cardiology | $351 | $971 | $1,526 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $294 | $983 | $1,686 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $46 | $163 | $271 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $34 | $84 | $108 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $113 | $290 | $496 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $140 | $205 | $266 |