| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $184 | $184 | $184 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $142 | $142 | $142 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $44 | $54 | $63 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $57 | $65 | $73 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $2 | $4 | $6 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $111 | $111 | $111 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $75 | $84 | $94 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $112 | $129 | $146 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $115 | $115 | $115 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $69 | $69 | $69 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $13 | $13 | $13 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $60 | $60 | $60 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $318 | $318 | $318 |
| Septoplasty CPT 30520 • ENT | $558 | $642 | $725 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $241 | $241 | $241 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $73 | $103 | $133 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $283 | $306 | $329 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $471 | $471 | $471 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $370 | $370 | $370 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $206 | $206 | $206 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $303 | $303 | $303 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $432 | $432 | $432 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $152 | $152 | $152 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $327 | $327 | $327 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $341 | $341 | $341 |
| Tonsillectomy primary under age 12 CPT 42826 • ENT | $284 | $284 | $284 |
| Adenoidectomy primary under age 12 CPT 42830 • ENT | $235 | $235 | $235 |
| Removal impacted cerumen unilateral CPT 69210 • ENT | $35 | $36 | $38 |
| Tympanostomy tube insertion CPT 69436 • ENT | $177 | $191 | $206 |
| Tympanoplasty without mastoidectomy CPT 69631 • ENT | $988 | $988 | $988 |
| Tympanoplasty with mastoidectomy CPT 69633 • ENT | $1,167 | $1,167 | $1,167 |
| Comprehensive audiometry evaluation CPT 92557 • ENT | $32 | $33 | $34 |
| Incision and drainage abscess simple CPT 10060 • Emergency | $94 | $115 | $135 |
| Incision and drainage abscess complicated CPT 10061 • Emergency | $155 | $185 | $206 |
| Simple wound repair up to 2.5cm CPT 12001 • Emergency | $52 | $101 | $179 |
| Simple wound repair 2.6-7.5cm CPT 12002 • Emergency | $124 | $157 | $190 |
| Simple wound repair face 2.5cm or less CPT 12011 • Emergency | $65 | $127 | $189 |
| Intermediate wound repair 2.5cm or less CPT 12031 • Emergency | $172 | $203 | $223 |
| Intermediate wound repair face 2.5cm or less CPT 12051 • Emergency | $121 | $156 | $192 |
| Initial treatment first degree burn CPT 16000 • Emergency | $82 | $82 | $82 |
| Emergency department visit self-limited problem CPT 99281 • Emergency | $24 | $24 | $24 |
| Emergency department visit low severity CPT 99282 • Emergency | $45 | $45 | $45 |
| Emergency department visit moderate severity CPT 99283 • Emergency | $66 | $67 | $68 |
| Emergency department visit high severity CPT 99284 • Emergency | $113 | $119 | $124 |
| Emergency department visit highest severity CPT 99285 • Emergency | $180 | $180 | $180 |
| Critical care first 30-74 minutes CPT 99291 • Emergency | $198 | $214 | $231 |
| Critical care each additional 30 minutes CPT 99292 • Emergency | $128 | $128 | $128 |
| Esophagoscopy rigid diagnostic CPT 43191 • Gastroenterology | $176 | $176 | $176 |
| Upper GI endoscopy diagnostic CPT 43235 • Gastroenterology | $144 | $228 | $312 |
| Upper GI endoscopy with biopsy CPT 43239 • Gastroenterology | $115 | $265 | $415 |