| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $114 | $114 | $114 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $209 | $209 | $209 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $247 | $247 | $247 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $181 | $181 | $181 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $139 | $139 | $139 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $109 | $109 | $109 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $57 | $72 | $82 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $3 | $5 | $8 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $110 | $110 | $110 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $76 | $85 | $94 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $94 | $103 | $112 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $71 | $71 | $71 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $160 | $160 | $160 |
| 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 | $487 | $487 | $487 |
| Septoplasty CPT 30520 • ENT | $558 | $627 | $696 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $251 | $251 | $251 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $58 | $143 | $229 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $183 | $256 | $329 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $309 | $309 | $309 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $454 | $454 | $454 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $224 | $224 | $224 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $360 | $360 | $360 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $573 | $573 | $573 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $214 | $214 | $214 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $330 | $330 | $330 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $343 | $343 | $343 |
| Tonsillectomy primary under age 12 CPT 42826 • ENT | $286 | $286 | $286 |
| Adenoidectomy primary under age 12 CPT 42830 • ENT | $236 | $236 | $236 |
| Removal impacted cerumen unilateral CPT 69210 • ENT | $35 | $43 | $55 |
| Tympanostomy tube insertion CPT 69436 • ENT | $181 | $193 | $206 |
| Tympanoplasty without mastoidectomy CPT 69631 • ENT | $995 | $995 | $995 |
| Tympanoplasty with mastoidectomy CPT 69633 • ENT | $1,174 | $1,174 | $1,174 |
| Comprehensive audiometry evaluation CPT 92557 • ENT | $34 | $37 | $40 |
| Incision and drainage abscess simple CPT 10060 • Emergency | $94 | $115 | $145 |
| Incision and drainage abscess complicated CPT 10061 • Emergency | $178 | $218 | $249 |
| Simple wound repair up to 2.5cm CPT 12001 • Emergency | $51 | $62 | $72 |
| Simple wound repair 2.6-7.5cm CPT 12002 • Emergency | $119 | $119 | $119 |
| Simple wound repair face 2.5cm or less CPT 12011 • Emergency | $63 | $63 | $63 |
| Intermediate wound repair 2.5cm or less CPT 12031 • Emergency | $169 | $196 | $223 |
| Intermediate wound repair face 2.5cm or less CPT 12051 • Emergency | $121 | $200 | $280 |
| Initial treatment first degree burn CPT 16000 • Emergency | $52 | $52 | $52 |
| Emergency department visit self-limited problem CPT 99281 • Emergency | $21 | $21 | $21 |
| Emergency department visit low severity CPT 99282 • Emergency | $41 | $42 | $43 |
| Emergency department visit moderate severity CPT 99283 • Emergency | $61 | $68 | $74 |
| Emergency department visit high severity CPT 99284 • Emergency | $117 | $121 | $126 |
| Emergency department visit highest severity CPT 99285 • Emergency | $172 | $209 | $245 |
| Critical care first 30-74 minutes CPT 99291 • Emergency | $222 | $251 | $280 |
| Critical care each additional 30 minutes CPT 99292 • Emergency | $111 | $126 | $142 |