| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $96 | $96 | $96 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $84 | $84 | $84 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $34 | $34 | $34 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $100 | $100 | $100 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $80 | $80 | $80 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $88 | $88 | $88 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $81 | $81 | $81 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $155 | $155 | $155 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $178 | $178 | $178 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $190 | $190 | $190 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $85 | $85 | $85 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $42 | $42 | $42 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $5 | $5 | $5 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $132 | $132 | $132 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $89 | $89 | $89 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $104 | $104 | $104 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $92 | $92 | $92 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $122 | $122 | $122 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $78 | $78 | $78 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $84 | $84 | $84 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $215 | $215 | $215 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $498 | $498 | $498 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $318 | $318 | $318 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $177 | $177 | $177 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $305 | $305 | $305 |
| Septoplasty CPT 30520 • ENT | $697 | $697 | $697 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $159 | $159 | $159 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $197 | $197 | $197 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $262 | $262 | $262 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $453 | $453 | $453 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $321 | $321 | $321 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $178 | $178 | $178 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $262 | $262 | $262 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $374 | $374 | $374 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $132 | $162 | $192 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $283 | $283 | $283 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $296 | $296 | $296 |
| Tonsillectomy primary under age 12 CPT 42826 • ENT | $249 | $249 | $249 |
| Adenoidectomy primary under age 12 CPT 42830 • ENT | $208 | $208 | $208 |
| Removal impacted cerumen unilateral CPT 69210 • ENT | $30 | $30 | $30 |
| Tympanostomy tube insertion CPT 69436 • ENT | $150 | $150 | $150 |
| Tympanoplasty without mastoidectomy CPT 69631 • ENT | $850 | $850 | $850 |
| Tympanoplasty with mastoidectomy CPT 69633 • ENT | $1,002 | $1,002 | $1,002 |
| Comprehensive audiometry evaluation CPT 92557 • ENT | $29 | $29 | $29 |
| Incision and drainage abscess simple CPT 10060 • Emergency | $97 | $97 | $97 |
| Incision and drainage abscess complicated CPT 10061 • Emergency | $164 | $164 | $164 |
| Simple wound repair up to 2.5cm CPT 12001 • Emergency | $72 | $72 | $72 |
| Simple wound repair 2.6-7.5cm CPT 12002 • Emergency | $44 | $44 | $44 |
| Simple wound repair face 2.5cm or less CPT 12011 • Emergency | $87 | $87 | $87 |
| Intermediate wound repair 2.5cm or less CPT 12031 • Emergency | $114 | $114 | $114 |