| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $159 | $159 | $159 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $38 | $38 | $38 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $18 | $18 | $18 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $2 | $2 | $2 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $77 | $77 | $77 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $36 | $36 | $36 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $44 | $44 | $44 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $62 | $62 | $62 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $81 | $81 | $81 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $58 | $58 | $58 |
| Septoplasty CPT 30520 • ENT | $353 | $353 | $353 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $50 | $50 | $50 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $21 | $21 | $21 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $84 | $84 | $84 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $125 | $125 | $125 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $105 | $105 | $105 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $59 | $59 | $59 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $86 | $86 | $86 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $195 | $195 | $195 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $71 | $71 | $71 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $230 | $230 | $230 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $160 | $160 | $160 |
| Tonsillectomy primary under age 12 CPT 42826 • ENT | $85 | $85 | $85 |
| Adenoidectomy primary under age 12 CPT 42830 • ENT | $168 | $168 | $168 |
| Removal impacted cerumen unilateral CPT 69210 • ENT | $37 | $37 | $37 |
| Tympanostomy tube insertion CPT 69436 • ENT | $84 | $84 | $84 |
| Tympanoplasty without mastoidectomy CPT 69631 • ENT | $697 | $697 | $697 |
| Tympanoplasty with mastoidectomy CPT 69633 • ENT | $346 | $346 | $346 |
| Comprehensive audiometry evaluation CPT 92557 • ENT | $16 | $16 | $16 |
| Incision and drainage abscess simple CPT 10060 • Emergency | $84 | $84 | $84 |
| Incision and drainage abscess complicated CPT 10061 • Emergency | $144 | $144 | $144 |
| Simple wound repair up to 2.5cm CPT 12001 • Emergency | $74 | $74 | $74 |
| Simple wound repair 2.6-7.5cm CPT 12002 • Emergency | $89 | $89 | $89 |
| Simple wound repair face 2.5cm or less CPT 12011 • Emergency | $88 | $88 | $88 |
| Intermediate wound repair 2.5cm or less CPT 12031 • Emergency | $118 | $118 | $118 |
| Intermediate wound repair face 2.5cm or less CPT 12051 • Emergency | $221 | $221 | $221 |
| Initial treatment first degree burn CPT 16000 • Emergency | $62 | $62 | $62 |
| Emergency department visit self-limited problem CPT 99281 • Emergency | $11 | $11 | $11 |
| Emergency department visit low severity CPT 99282 • Emergency | $21 | $21 | $21 |
| Emergency department visit moderate severity CPT 99283 • Emergency | $36 | $36 | $36 |
| Emergency department visit high severity CPT 99284 • Emergency | $62 | $62 | $62 |
| Emergency department visit highest severity CPT 99285 • Emergency | $89 | $89 | $89 |
| Critical care first 30-74 minutes CPT 99291 • Emergency | $141 | $141 | $141 |
| Critical care each additional 30 minutes CPT 99292 • Emergency | $62 | $62 | $62 |
| Esophagoscopy rigid diagnostic CPT 43191 • Gastroenterology | $81 | $81 | $81 |
| Upper GI endoscopy diagnostic CPT 43235 • Gastroenterology | $94 | $94 | $94 |
| Upper GI endoscopy with biopsy CPT 43239 • Gastroenterology | $45 | $45 | $45 |
| Upper GI endoscopy with foreign body removal CPT 43247 • Gastroenterology | $135 | $135 | $135 |
| Upper GI endoscopy with balloon dilation CPT 43249 • Gastroenterology | $118 | $118 | $118 |
| Upper GI endoscopy with polypectomy by snare CPT 43251 • Gastroenterology | $256 | $256 | $256 |