| Allergen specific IgE each allergen CPT 86003 • Allergy | $4 | $5 | $9 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $5 | $10 | $29 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $3 | $7 | $13 |
| Allergy testing insect venoms CPT 95017 • Allergy | $4 | $12 | $25 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $7 | $34 | $77 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $1 | $13 | $31 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $8 | $20 | $40 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $10 | $22 | $48 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $3 | $13 | $38 |
| Sublingual allergen immunotherapy CPT 95199 • Allergy | $0 | $0 | $0 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $3 | $285 | $995 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $3 | $286 | $995 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $3 | $285 | $995 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $3 | $213 | $870 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $3 | $271 | $995 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $3 | $328 | $949 |
| 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 | $3 | $300 | $995 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $3 | $287 | $995 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $3 | $328 | $949 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $3 | $312 | $995 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $3 | $287 | $995 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $3 | $422 | $1,000 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $3 | $555 | $1,750 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $30 | $943 | $2,214 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $157 | $1,835 | $3,902 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $30 | $3,178 | $6,714 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $331 | $4,153 | $9,321 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $2,353 | $5,845 | $10,368 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $505 | $946 | $1,962 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $485 | $890 | $2,187 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $14 | $31 | $54 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $4 | $14 | $27 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $8 | $15 | $30 |
| Cardiovascular stress test CPT 93015 • Cardiology | $62 | $139 | $274 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $33 | $73 | $133 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $78 | $159 | $276 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $79 | $414 | $999 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $73 | $247 | $833 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $68 | $296 | $752 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $103 | $292 | $897 |
| Stress echocardiography CPT 93350 • Cardiology | $30 | $289 | $709 |
| Left and right heart catheterization CPT 93452 • Cardiology | $337 | $884 | $1,769 |
| Left heart catheterization CPT 93458 • Cardiology | $251 | $1,116 | $2,966 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $285 | $1,042 | $1,576 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $32 | $249 | $631 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $11 | $92 | $262 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $31 | $409 | $925 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $32 | $204 | $456 |