| Allergen specific IgE each allergen CPT 86003 • Allergy | $4 | $10 | $18 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $3 | $14 | $28 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $10 | $19 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $14 | $25 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $5 | $28 | $63 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $1 | $13 | $23 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $8 | $22 | $36 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $13 | $28 | $46 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $23 | $42 |
| Sublingual allergen immunotherapy CPT 95199 • Allergy | $0 | $0 | $0 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $6 | $281 | $732 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $6 | $348 | $899 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $5 | $312 | $899 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $5 | $206 | $488 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $5 | $460 | $1,001 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $5 | $368 | $1,098 |
| Anesthesia for upper GI endoscopy CPT 00740 • Anesthesia | $119 | $200 | $282 |
| Anesthesia for lower GI endoscopy CPT 00810 • Anesthesia | $119 | $200 | $282 |
| Anesthesia for abdominal wall surgery CPT 00840 • Anesthesia | $6 | $421 | $1,049 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $5 | $352 | $899 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $6 | $435 | $1,098 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $5 | $421 | $976 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $6 | $347 | $899 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $6 | $756 | $2,896 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $6 | $509 | $1,967 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $513 | $4,708 | $15,291 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $851 | $4,369 | $15,291 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $328 | $3,092 | $4,813 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $331 | $4,601 | $9,321 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $1,971 | $5,048 | $10,368 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $486 | $6,832 | $24,703 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $553 | $7,059 | $24,703 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $13 | $36 | $55 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $7 | $16 | $32 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $7 | $17 | $28 |
| Cardiovascular stress test CPT 93015 • Cardiology | $77 | $165 | $268 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $29 | $76 | $133 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $76 | $177 | $303 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $102 | $405 | $988 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $91 | $375 | $798 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $66 | $375 | $743 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $128 | $540 | $927 |
| Stress echocardiography CPT 93350 • Cardiology | $60 | $273 | $602 |
| Left and right heart catheterization CPT 93452 • Cardiology | $188 | $3,645 | $15,291 |
| Left heart catheterization CPT 93458 • Cardiology | $283 | $3,988 | $15,291 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $307 | $4,971 | $15,291 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $64 | $342 | $538 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $12 | $186 | $326 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $62 | $472 | $792 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $54 | $376 | $622 |