| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $114 | $114 | $114 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $59 | $59 | $59 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $57 | $66 | $74 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $5 | $5 | $6 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $166 | $166 | $166 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $64 | $79 | $94 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $80 | $96 | $112 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $67 | $67 | $67 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $67 | $67 | $67 |
| 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 | $407 | $407 | $407 |
| Septoplasty CPT 30520 • ENT | $573 | $573 | $573 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $125 | $125 | $125 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $133 | $156 | $179 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $313 | $321 | $329 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $278 | $278 | $278 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $411 | $411 | $411 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $201 | $201 | $201 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $324 | $324 | $324 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $518 | $518 | $518 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $131 | $131 | $131 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $285 | $285 | $285 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $298 | $298 | $298 |
| Tonsillectomy primary under age 12 CPT 42826 • ENT | $246 | $246 | $246 |
| Adenoidectomy primary under age 12 CPT 42830 • ENT | $201 | $201 | $201 |
| Removal impacted cerumen unilateral CPT 69210 • ENT | $32 | $33 | $35 |
| Tympanostomy tube insertion CPT 69436 • ENT | $159 | $182 | $206 |
| Tympanoplasty without mastoidectomy CPT 69631 • ENT | $846 | $846 | $846 |
| Tympanoplasty with mastoidectomy CPT 69633 • ENT | $1,001 | $1,001 | $1,001 |
| Comprehensive audiometry evaluation CPT 92557 • ENT | $32 | $38 | $44 |
| Incision and drainage abscess simple CPT 10060 • Emergency | $94 | $99 | $103 |
| Incision and drainage abscess complicated CPT 10061 • Emergency | $155 | $156 | $158 |
| Simple wound repair up to 2.5cm CPT 12001 • Emergency | $138 | $138 | $138 |
| Simple wound repair 2.6-7.5cm CPT 12002 • Emergency | $147 | $147 | $147 |
| Simple wound repair face 2.5cm or less CPT 12011 • Emergency | $102 | $102 | $102 |
| Intermediate wound repair 2.5cm or less CPT 12031 • Emergency | $150 | $186 | $223 |
| Intermediate wound repair face 2.5cm or less CPT 12051 • Emergency | $121 | $146 | $172 |
| Initial treatment first degree burn CPT 16000 • Emergency | $46 | $46 | $46 |
| Emergency department visit self-limited problem CPT 99281 • Emergency | $21 | $21 | $21 |
| Emergency department visit low severity CPT 99282 • Emergency | $41 | $41 | $41 |
| Emergency department visit moderate severity CPT 99283 • Emergency | $64 | $64 | $64 |
| Emergency department visit high severity CPT 99284 • Emergency | $113 | $117 | $120 |
| Emergency department visit highest severity CPT 99285 • Emergency | $179 | $179 | $179 |
| Critical care first 30-74 minutes CPT 99291 • Emergency | $198 | $233 | $268 |
| Critical care each additional 30 minutes CPT 99292 • Emergency | $121 | $121 | $121 |
| Esophagoscopy rigid diagnostic CPT 43191 • Gastroenterology | $137 | $137 | $137 |
| Upper GI endoscopy diagnostic CPT 43235 • Gastroenterology | $144 | $220 | $295 |
| Upper GI endoscopy with biopsy CPT 43239 • Gastroenterology | $115 | $144 | $174 |
| Upper GI endoscopy with foreign body removal CPT 43247 • Gastroenterology | $204 | $204 | $204 |