| Allergen specific IgE each allergen CPT 86003 • Allergy | $4 | $7 | $16 |
| Allergen specific IgE qualitative multi-allergen CPT 86005 • Allergy | $3 | $8 | $11 |
| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $4 | $7 | $20 |
| Allergy testing insect venoms CPT 95017 • Allergy | $3 | $10 | $25 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $5 | $22 | $61 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $1 | $10 | $24 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $8 | $11 | $13 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $9 | $14 | $16 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $2 | $12 | $39 |
| Sublingual allergen immunotherapy CPT 95199 • Allergy | $0 | $0 | $0 |
| Anesthesia for salivary gland procedures CPT 00100 • Anesthesia | $5 | $220 | $518 |
| Anesthesia for eye procedures CPT 00140 • Anesthesia | $5 | $220 | $518 |
| Anesthesia for head and neck procedures CPT 00300 • Anesthesia | $4 | $202 | $518 |
| Anesthesia for chest wall procedures CPT 00400 • Anesthesia | $3 | $139 | $346 |
| Anesthesia for chest procedures CPT 00520 • Anesthesia | $5 | $367 | $1,001 |
| Anesthesia for lumbar region procedures CPT 00630 • Anesthesia | $3 | $323 | $778 |
| 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 | $366 | $1,001 |
| Anesthesia for inguinal hernia repair CPT 00902 • Anesthesia | $4 | $220 | $518 |
| Anesthesia for total hip replacement CPT 01214 • Anesthesia | $3 | $323 | $778 |
| Anesthesia for total knee replacement CPT 01402 • Anesthesia | $4 | $268 | $691 |
| Anesthesia for hand and wrist procedures CPT 01630 • Anesthesia | $4 | $220 | $518 |
| Anesthesia for cesarean delivery CPT 01961 • Anesthesia | $4 | $887 | $2,896 |
| Anesthesia for epidural or spinal labor analgesia CPT 01967 • Anesthesia | $3 | $377 | $900 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $423 | $666 | $1,245 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $157 | $1,025 | $2,199 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $1,509 | $2,349 | $4,443 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $1,448 | $2,896 | $5,215 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $1,934 | $3,015 | $5,804 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $462 | $615 | $873 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $424 | $668 | $970 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $10 | $17 | $24 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $7 | $9 | $16 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $6 | $9 | $12 |
| Cardiovascular stress test CPT 93015 • Cardiology | $75 | $95 | $132 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $29 | $53 | $91 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $62 | $111 | $302 |
| External ECG recording up to 7 days CPT 93241 • Cardiology | $105 | $261 | $522 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $51 | $212 | $411 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $51 | $202 | $367 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $128 | $262 | $436 |
| Stress echocardiography CPT 93350 • Cardiology | $123 | $221 | $345 |
| Left and right heart catheterization CPT 93452 • Cardiology | $188 | $967 | $2,491 |
| Left heart catheterization CPT 93458 • Cardiology | $307 | $1,028 | $1,864 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $307 | $881 | $2,004 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $32 | $185 | $360 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $12 | $76 | $133 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $164 | $282 | $455 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $37 | $199 | $355 |