| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $123 | $156 | $189 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $149 | $154 | $158 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $180 | $180 | $180 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $207 | $229 | $251 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $152 | $209 | $265 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $183 | $204 | $224 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $77 | $109 | $142 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $53 | $63 | $74 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $7 | $10 | $12 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $180 | $193 | $206 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $103 | $123 | $142 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $81 | $113 | $145 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $41 | $87 | $133 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $74 | $115 | $156 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $84 | $84 | $84 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $320 | $382 | $444 |
| Septoplasty CPT 30520 • ENT | $576 | $619 | $663 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $235 | $241 | $246 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $203 | $210 | $217 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $232 | $262 | $291 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $358 | $418 | $478 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $277 | $404 | $531 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $156 | $207 | $259 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $227 | $323 | $419 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $322 | $496 | $671 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $197 | $208 | $219 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $274 | $306 | $338 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $286 | $326 | $367 |
| Tonsillectomy primary under age 12 CPT 42826 • ENT | $245 | $273 | $301 |
| Adenoidectomy primary under age 12 CPT 42830 • ENT | $208 | $224 | $240 |
| Removal impacted cerumen unilateral CPT 69210 • ENT | $40 | $51 | $62 |
| Tympanostomy tube insertion CPT 69436 • ENT | $154 | $176 | $199 |
| Tympanoplasty without mastoidectomy CPT 69631 • ENT | $858 | $920 | $982 |
| Tympanoplasty with mastoidectomy CPT 69633 • ENT | $1,007 | $1,090 | $1,174 |
| Comprehensive audiometry evaluation CPT 92557 • ENT | $39 | $45 | $51 |
| Incision and drainage abscess simple CPT 10060 • Emergency | $100 | $128 | $155 |
| Incision and drainage abscess complicated CPT 10061 • Emergency | $187 | $229 | $270 |
| Simple wound repair up to 2.5cm CPT 12001 • Emergency | $116 | $144 | $172 |
| Simple wound repair 2.6-7.5cm CPT 12002 • Emergency | $133 | $138 | $142 |
| Simple wound repair face 2.5cm or less CPT 12011 • Emergency | $141 | $162 | $182 |
| Intermediate wound repair 2.5cm or less CPT 12031 • Emergency | $149 | $236 | $322 |
| Intermediate wound repair face 2.5cm or less CPT 12051 • Emergency | $187 | $267 | $348 |
| Initial treatment first degree burn CPT 16000 • Emergency | $56 | $56 | $56 |
| Emergency department visit self-limited problem CPT 99281 • Emergency | $11 | $15 | $19 |
| Emergency department visit low severity CPT 99282 • Emergency | $31 | $36 | $41 |
| Emergency department visit moderate severity CPT 99283 • Emergency | $69 | $69 | $70 |
| Emergency department visit high severity CPT 99284 • Emergency | $108 | $113 | $119 |
| Emergency department visit highest severity CPT 99285 • Emergency | $169 | $171 | $172 |
| Critical care first 30-74 minutes CPT 99291 • Emergency | $231 | $281 | $331 |
| Critical care each additional 30 minutes CPT 99292 • Emergency | $126 | $134 | $141 |