Allergen specific IgE; quantitative or semiquantitative, each allergen
        
    
    
        
            
                up to $12*
            
        
    
                     
                
                    
                        
    
    
    
        
            Suction assisted lipectomy; trunk
        
    
    
        
            
                up to $4114*
            
        
    
                     
                
                    
                
                    
                        
    
    
    
        
            Dermabrasion; superficial, any site, (e.g., tattoo removal)
        
    
    
        
            
                up to $1738*
            
        
    
                     
                
                    
                        
    
    
    
        
            Biopsy of skin, subcutaneous tissue and/or mucous membrane
        
    
    
        
            
                up to $623*
            
        
    
                     
                
                    
                        
    
    
    
        
            Tissue transfer repair of nose, ear, eyelid, lip; defect 10 sq cm or less
        
    
    
        
            
                up to $10019*
            
        
    
                     
                
                    
                        
    
    
    
        
            MRI Brain without contrast material
        
    
    
        
            
                up to $1258*
            
        
    
                     
                
                    
                        
    
    
    
        
            Chemodenervation of muscle(s)
        
    
    
        
            
                up to $640*
            
        
    
                     
                
                    
                        
    
    
    
        
            Microdermabrasion
        
    
    
        
            
                up to $3226*
            
        
    
                     
                
                    
                        
    
    
    
        
            PDO Thread Lift
        
    
    
        
            
                up to $566*
            
        
    
                     
                
                    
                        
    
    
    
        
            Repair, intermediate, wounds of face, ears, eyelids, nose, lips; 5.1 cm to 7.5 cm
        
    
    
        
            
                up to $1039*
            
        
    
                     
                
                    
                        
    
    
    
        
            Subcutaneous injection of filling material, 1.1 to 5.0 cc
        
    
    
        
            
                up to $404*
            
        
    
                     
                
                    
                        
    
    
    
        
            Excision of malignant skin lesion, face, ears, eyelids, nose, lips; excised diameter 0.6 to 1.0 cm
        
    
    
        
            
                up to $811*
            
        
    
                     
                
                    
                        
    
    
    
        
            Photochemotherapy
        
    
    
        
            
                up to $164*
            
        
    
                     
                
                    
                        
    
    
    
        
            CT Brain without contrast material
        
    
    
        
            
                up to $647*
            
        
    
                     
                
                    
                        
    
    
    
        
            Pulsed Dye Laser (PDL) Treatment
        
    
    
        
            
                up to $1691*
            
        
    
                     
                
                    
                        
    
    
    
        
            Layer closure of wounds of face, ears, eyelids, nose, lips; 2.5 cm or less
        
    
    
        
            
                up to $1032*
            
        
    
                     
                
                    
                        
    
    
    
        
            Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 1.1 cm to 2.5 cm
        
    
    
        
            
                up to $1056*
            
        
    
                     
                
                    
                        
    
    
    
        
            Chemical cauterization of granulation tissue
        
    
    
        
            
                up to $270*
            
        
    
                     
                
                    
                        
    
    
    
        
            Intense Pulsed Light (IPL) Treatment
        
    
    
        
            
                up to $198*
            
        
    
                     
                
                    
                        
    
    
    
        
            Laser treatment of spider veins; 10 sq cm or more
        
    
    
        
            
                up to $177*
            
        
    
                     
                
                    
                        
    
    
    
        
            Repair of complex wound, face, ears, eyelids, nose, lips; 2.6 cm to 7.5 cm
        
    
    
        
            
                up to $4282*
            
        
    
                     
                
                    
                        
    
    
    
        
            Tissue culture for fungus
        
    
    
        
            
                up to $4*
            
        
    
                     
                
                    
                        
    
    
    
        
            Application of Unna boot
        
    
    
        
            
                up to $215*
            
        
    
                     
                
                    
                        
    
    
    
        
            Destruction of vulvar lesion(s), simple
        
    
    
        
            
                up to $904*
            
        
    
                     
                
                    
                        
    
    
    
        
            Herpes simplex virus, antibody; IgM
        
    
    
        
            
                up to $31*
            
        
    
                     
                
                    
                        
    
    
    
        
            Ultherapy (non-invasive skin tightening)
        
    
    
        
            
                up to $98*