| Allergen specific IgE each allergen CPT 86003 • Allergy | $3 | $6 | $13 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $5 | $9 | $20 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $7 | $11 |
| Allergy testing insect venoms CPT 95017 • Allergy | $5 | $10 | $15 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $7 | $28 | $51 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $2 | $7 | $12 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $9 | $14 | $28 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $10 | $17 | $32 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $4 | $11 | $32 |
| Sublingual allergen immunotherapy CPT 95199 • Allergy | $0 | $0 | $0 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $64 | $290 | $488 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $64 | $290 | $488 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $64 | $290 | $488 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $64 | $200 | $325 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $64 | $571 | $1,079 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $64 | $424 | $732 |
| 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 | $571 | $1,079 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $64 | $290 | $488 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $37 | $193 | $477 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $64 | $380 | $651 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $64 | $290 | $488 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $64 | $738 | $1,500 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $64 | $509 | $900 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $357 | $841 | $1,348 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,181 | $1,693 | $2,229 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $1,771 | $3,010 | $4,547 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $379 | $3,363 | $5,339 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,648 | $4,281 | $6,232 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $509 | $955 | $1,272 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $566 | $944 | $1,414 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $15 | $25 | $38 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $8 | $11 | $18 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $27 | $116 |
| Cardiovascular stress test CPT 93015 • Cardiology | $62 | $110 | $187 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $44 | $74 | $100 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $82 | $130 | $182 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $146 | $265 | $698 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $60 | $290 | $556 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $68 | $225 | $500 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $103 | $310 | $597 |
| Stress echocardiography CPT 93350 • Cardiology | $62 | $273 | $523 |
| Left and right heart catheterization CPT 93452 • Cardiology | $481 | $834 | $1,281 |
| Left heart catheterization CPT 93458 • Cardiology | $708 | $1,373 | $2,966 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $317 | $1,159 | $2,602 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $28 | $125 | $238 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $11 | $55 | $121 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $43 | $168 | $305 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $44 | $138 | $266 |