| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $103 | $242 | $312 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $137 | $240 | $360 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $211 | $341 | $384 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $176 | $230 | $320 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $37 | $97 | $181 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $53 | $75 | $102 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $2 | $15 | $30 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $164 | $206 | $256 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $99 | $150 | $175 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $77 | $173 | $205 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $39 | $39 | $39 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $70 | $191 | $251 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $8 | $42 | $77 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $369 | $369 | $369 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $1,015 | $1,015 | $1,015 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $426 | $452 | $461 |
| Septoplasty CPT 30520 • ENT | $553 | $882 | $1,047 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $226 | $226 | $226 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $195 | $267 | $303 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $362 | $386 | $398 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $344 | $402 | $432 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $510 | $510 | $510 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $248 | $248 | $248 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $259 | $358 | $413 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $644 | $644 | $644 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $189 | $189 | $189 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $325 | $409 | $451 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $30 | $284 | $471 |
| Tonsillectomy primary under age 12 CPT 42826 • ENT | $289 | $358 | $393 |
| Adenoidectomy primary under age 12 CPT 42830 • ENT | $230 | $293 | $325 |
| Removal impacted cerumen unilateral CPT 69210 • ENT | $56 | $68 | $74 |
| Tympanostomy tube insertion CPT 69436 • ENT | $191 | $232 | $245 |
| Tympanoplasty without mastoidectomy CPT 69631 • ENT | $942 | $942 | $942 |
| Tympanoplasty with mastoidectomy CPT 69633 • ENT | $1,127 | $1,127 | $1,127 |
| Comprehensive audiometry evaluation CPT 92557 • ENT | $49 | $56 | $60 |
| Incision and drainage abscess simple CPT 10060 • Emergency | $108 | $164 | $192 |
| Incision and drainage abscess complicated CPT 10061 • Emergency | $180 | $239 | $330 |
| Simple wound repair up to 2.5cm CPT 12001 • Emergency | $91 | $134 | $165 |
| Simple wound repair 2.6-7.5cm CPT 12002 • Emergency | $110 | $138 | $176 |
| Simple wound repair face 2.5cm or less CPT 12011 • Emergency | $118 | $157 | $176 |
| Intermediate wound repair 2.5cm or less CPT 12031 • Emergency | $143 | $343 | $410 |
| Intermediate wound repair face 2.5cm or less CPT 12051 • Emergency | $256 | $395 | $441 |
| Initial treatment first degree burn CPT 16000 • Emergency | $54 | $54 | $54 |
| Emergency department visit self-limited problem CPT 99281 • Emergency | $18 | $18 | $18 |
| Emergency department visit low severity CPT 99282 • Emergency | $29 | $29 | $29 |
| Emergency department visit moderate severity CPT 99283 • Emergency | $66 | $98 | $114 |
| Emergency department visit high severity CPT 99284 • Emergency | $103 | $151 | $193 |
| Emergency department visit highest severity CPT 99285 • Emergency | $161 | $242 | $282 |
| Critical care first 30-74 minutes CPT 99291 • Emergency | $221 | $364 | $436 |
| Critical care each additional 30 minutes CPT 99292 • Emergency | $121 | $121 | $121 |