| Percutaneous allergy skin test each allergen CPT 95004 • Allergy | $10 | $10 | $10 |
| Allergy testing insect venoms CPT 95017 • Allergy | $13 | $13 | $13 |
| Allergy testing drugs or biologicals CPT 95018 • Allergy | $32 | $32 | $32 |
| Intracutaneous allergy test each allergen CPT 95024 • Allergy | $13 | $13 | $13 |
| Allergen immunotherapy injection single CPT 95115 • Allergy | $15 | $15 | $15 |
| Allergen immunotherapy injection multiple CPT 95117 • Allergy | $17 | $17 | $17 |
| Allergen immunotherapy antigen preparation multi-dose CPT 95165 • Allergy | $21 | $21 | $21 |
| Permanent pacemaker insertion CPT 33208 • Cardiology | $1,078 | $1,078 | $1,078 |
| Implantable defibrillator insertion CPT 33249 • Cardiology | $1,876 | $1,876 | $1,876 |
| Coronary artery bypass graft (CABG) single CPT 33533 • Cardiology | $3,806 | $3,806 | $3,806 |
| Coronary artery bypass graft (CABG) two grafts CPT 33534 • Cardiology | $4,479 | $4,479 | $4,479 |
| Coronary artery bypass graft (CABG) three grafts CPT 33535 • Cardiology | $4,998 | $4,998 | $4,998 |
| Percutaneous coronary angioplasty single vessel CPT 92920 • Cardiology | $947 | $947 | $947 |
| Percutaneous coronary stent single vessel CPT 92928 • Cardiology | $1,051 | $1,051 | $1,051 |
| Electrocardiogram (ECG) 12-lead CPT 93000 • Cardiology | $29 | $29 | $29 |
| Electrocardiogram tracing only CPT 93005 • Cardiology | $14 | $14 | $14 |
| Electrocardiogram interpretation only CPT 93010 • Cardiology | $15 | $15 | $15 |
| Cardiovascular stress test CPT 93015 • Cardiology | $129 | $129 | $129 |
| Cardiovascular stress test tracing only CPT 93017 • Cardiology | $65 | $65 | $65 |
| Holter monitor up to 48 hours CPT 93224 • Cardiology | $153 | $153 | $153 |
| Echocardiography transthoracic limited CPT 93303 • Cardiology | $396 | $396 | $396 |
| Echocardiography transthoracic complete CPT 93306 • Cardiology | $379 | $379 | $379 |
| Echocardiography transesophageal CPT 93312 • Cardiology | $514 | $514 | $514 |
| Stress echocardiography CPT 93350 • Cardiology | $402 | $402 | $402 |
| Left and right heart catheterization CPT 93452 • Cardiology | $1,479 | $1,479 | $1,479 |
| Left heart catheterization CPT 93458 • Cardiology | $1,794 | $1,794 | $1,794 |
| Left heart catheterization with ventriculography CPT 93459 • Cardiology | $1,983 | $1,983 | $1,983 |
| Duplex scan extracranial arteries CPT 93880 • Cardiology | $337 | $337 | $337 |
| Non-invasive physiologic study extremity arteries CPT 93922 • Cardiology | $149 | $149 | $149 |
| Duplex scan lower extremity arteries CPT 93925 • Cardiology | $377 | $377 | $377 |
| Duplex scan extremity veins complete CPT 93970 • Cardiology | $329 | $329 | $329 |
| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $123 | $123 | $123 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $30 | $30 | $30 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $117 | $117 | $117 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $260 | $260 | $260 |
| Removal impacted cerumen unilateral CPT 69210 • ENT | $30 | $30 | $30 |
| Comprehensive audiometry evaluation CPT 92557 • ENT | $64 | $64 | $64 |
| Incision and drainage abscess simple CPT 10060 • Emergency | $30 | $30 | $30 |
| Incision and drainage abscess complicated CPT 10061 • Emergency | $30 | $30 | $30 |
| Simple wound repair up to 2.5cm CPT 12001 • Emergency | $30 | $30 | $30 |
| Simple wound repair 2.6-7.5cm CPT 12002 • Emergency | $30 | $30 | $30 |
| Emergency department visit self-limited problem CPT 99281 • Emergency | $33 | $33 | $33 |
| Emergency department visit low severity CPT 99282 • Emergency | $76 | $76 | $76 |
| Emergency department visit moderate severity CPT 99283 • Emergency | $97 | $97 | $97 |
| Emergency department visit high severity CPT 99284 • Emergency | $184 | $184 | $184 |
| Emergency department visit highest severity CPT 99285 • Emergency | $272 | $272 | $272 |
| Critical care first 30-74 minutes CPT 99291 • Emergency | $424 | $424 | $424 |
| Critical care each additional 30 minutes CPT 99292 • Emergency | $190 | $190 | $190 |
| Esophageal motility study CPT 91010 • Gastroenterology | $299 | $299 | $299 |
| Esophageal motility study with acid reflux CPT 91035 • Gastroenterology | $807 | $807 | $807 |