| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $132 | $132 | $132 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $277 | $277 | $277 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $306 | $306 | $306 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $178 | $178 | $178 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $83 | $83 | $83 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $68 | $68 | $68 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $15 | $15 | $15 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $200 | $200 | $200 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $53 | $53 | $53 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $71 | $71 | $71 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $27 | $27 | $27 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $482 | $482 | $482 |
| Septoplasty CPT 30520 • ENT | $1,064 | $1,064 | $1,064 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $94 | $94 | $94 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $163 | $163 | $163 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $336 | $336 | $336 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $798 | $798 | $798 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $1,229 | $1,229 | $1,229 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $581 | $581 | $581 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $895 | $895 | $895 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $1,329 | $1,329 | $1,329 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $130 | $130 | $130 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $597 | $597 | $597 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $404 | $404 | $404 |
| Tonsillectomy primary under age 12 CPT 42826 • ENT | $574 | $574 | $574 |
| Adenoidectomy primary under age 12 CPT 42830 • ENT | $334 | $334 | $334 |
| Removal impacted cerumen unilateral CPT 69210 • ENT | $62 | $62 | $62 |
| Tympanostomy tube insertion CPT 69436 • ENT | $355 | $355 | $355 |
| Tympanoplasty without mastoidectomy CPT 69631 • ENT | $1,702 | $1,702 | $1,702 |
| Tympanoplasty with mastoidectomy CPT 69633 • ENT | $1,852 | $1,852 | $1,852 |
| Comprehensive audiometry evaluation CPT 92557 • ENT | $72 | $72 | $72 |
| Incision and drainage abscess simple CPT 10060 • Emergency | $80 | $80 | $80 |
| Incision and drainage abscess complicated CPT 10061 • Emergency | $147 | $147 | $147 |
| Simple wound repair up to 2.5cm CPT 12001 • Emergency | $124 | $124 | $124 |
| Simple wound repair 2.6-7.5cm CPT 12002 • Emergency | $137 | $137 | $137 |
| Simple wound repair face 2.5cm or less CPT 12011 • Emergency | $132 | $132 | $132 |
| Intermediate wound repair 2.5cm or less CPT 12031 • Emergency | $152 | $152 | $152 |
| Intermediate wound repair face 2.5cm or less CPT 12051 • Emergency | $180 | $180 | $180 |
| Initial treatment first degree burn CPT 16000 • Emergency | $61 | $61 | $61 |
| Emergency department visit self-limited problem CPT 99281 • Emergency | $25 | $25 | $25 |
| Emergency department visit low severity CPT 99282 • Emergency | $40 | $40 | $40 |
| Emergency department visit moderate severity CPT 99283 • Emergency | $75 | $75 | $75 |
| Emergency department visit high severity CPT 99284 • Emergency | $109 | $109 | $109 |
| Emergency department visit highest severity CPT 99285 • Emergency | $172 | $172 | $172 |
| Critical care first 30-74 minutes CPT 99291 • Emergency | $224 | $224 | $224 |
| Critical care each additional 30 minutes CPT 99292 • Emergency | $97 | $97 | $97 |
| Upper GI endoscopy diagnostic CPT 43235 • Gastroenterology | $372 | $372 | $372 |
| Upper GI endoscopy with biopsy CPT 43239 • Gastroenterology | $425 | $425 | $425 |
| Upper GI endoscopy with foreign body removal CPT 43247 • Gastroenterology | $499 | $499 | $499 |
| Upper GI endoscopy with balloon dilation CPT 43249 • Gastroenterology | $627 | $627 | $627 |