Allergen specific IgE; quantitative or semiquantitative, each allergen
        
    
    
        
            
                up to $12*
            
        
    
                     
                
                    
                        
    
    
    
        
            Suction assisted lipectomy; trunk
        
    
    
        
            
                up to $1725*
            
        
    
                     
                
                    
                
                    
                        
    
    
    
        
            Dermabrasion; superficial, any site, (e.g., tattoo removal)
        
    
    
        
            
                up to $1992*
            
        
    
                     
                
                    
                        
    
    
    
        
            Biopsy of skin, subcutaneous tissue and/or mucous membrane
        
    
    
        
            
                up to $549*
            
        
    
                     
                
                    
                        
    
    
    
        
            Tissue transfer repair of nose, ear, eyelid, lip; defect 10 sq cm or less
        
    
    
        
            
                up to $3421*
            
        
    
                     
                
                    
                        
    
    
    
        
            MRI Brain without contrast material
        
    
    
        
            
                up to $722*
            
        
    
                     
                
                    
                        
    
    
    
        
            Chemodenervation of muscle(s)
        
    
    
        
            
                up to $604*
            
        
    
                     
                
                    
                        
    
    
    
        
            Microdermabrasion
        
    
    
        
            
                up to $3450*
            
        
    
                     
                
                    
                        
    
    
    
        
            PDO Thread Lift
        
    
    
        
            
                up to $713*
            
        
    
                     
                
                    
                        
    
    
    
        
            Repair, intermediate, wounds of face, ears, eyelids, nose, lips; 5.1 cm to 7.5 cm
        
    
    
        
            
                up to $1176*
            
        
    
                     
                
                    
                        
    
    
    
        
            Subcutaneous injection of filling material, 1.1 to 5.0 cc
        
    
    
        
            
                up to $419*
            
        
    
                     
                
                    
                        
    
    
    
        
            Excision of malignant skin lesion, face, ears, eyelids, nose, lips; excised diameter 0.6 to 1.0 cm
        
    
    
        
            
                up to $844*
            
        
    
                     
                
                    
                        
    
    
    
        
            Photochemotherapy
        
    
    
        
            
                up to $198*
            
        
    
                     
                
                    
                        
    
    
    
        
            CT Brain without contrast material
        
    
    
        
            
                up to $364*
            
        
    
                     
                
                    
                        
    
    
    
        
            Pulsed Dye Laser (PDL) Treatment
        
    
    
        
            
                up to $1702*
            
        
    
                     
                
                    
                        
    
    
    
        
            Layer closure of wounds of face, ears, eyelids, nose, lips; 2.5 cm or less
        
    
    
        
            
                up to $968*
            
        
    
                     
                
                    
                        
    
    
    
        
            Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 1.1 cm to 2.5 cm
        
    
    
        
            
                up to $1204*
            
        
    
                     
                
                    
                        
    
    
    
        
            Chemical cauterization of granulation tissue
        
    
    
        
            
                up to $255*
            
        
    
                     
                
                    
                        
    
    
    
        
            Intense Pulsed Light (IPL) Treatment
        
    
    
        
            
                up to $149*
            
        
    
                     
                
                    
                        
    
    
    
        
            Laser treatment of spider veins; 10 sq cm or more
        
    
    
        
            
                up to $204*
            
        
    
                     
                
                    
                        
    
    
    
        
            Repair of complex wound, face, ears, eyelids, nose, lips; 2.6 cm to 7.5 cm
        
    
    
        
            
                up to $1460*
            
        
    
                     
                
                    
                        
    
    
    
        
            Tissue culture for fungus
        
    
    
        
            
                up to $11*
            
        
    
                     
                
                    
                        
    
    
    
        
            Application of Unna boot
        
    
    
        
            
                up to $168*
            
        
    
                     
                
                    
                        
    
    
    
        
            Destruction of vulvar lesion(s), simple
        
    
    
        
            
                up to $577*
            
        
    
                     
                
                    
                        
    
    
    
        
            Herpes simplex virus, antibody; IgM
        
    
    
        
            
                up to $32*
            
        
    
                     
                
                    
                        
    
    
    
        
            Ultherapy (non-invasive skin tightening)
        
    
    
        
            
                up to $98*