| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $151 | $164 | $177 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $192 | $204 | $217 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $316 | $316 | $316 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $198 | $230 | $263 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $363 | $363 | $363 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $270 | $270 | $270 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $192 | $320 | $447 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $373 | $373 | $373 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $160 | $160 | $160 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $93 | $93 | $93 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $9 | $11 | $12 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $156 | $181 | $206 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $103 | $172 | $242 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $106 | $106 | $106 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $148 | $148 | $148 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $5 | $5 | $5 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $2 | $2 | $2 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $11 | $36 | $61 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $49 | $49 | $49 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $615 | $615 | $615 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $159 | $159 | $159 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $51 | $51 | $51 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $619 | $619 | $619 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $7,188 | $7,188 | $7,188 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $24 | $24 | $24 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $2,708 | $2,708 | $2,708 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $189 | $189 | $189 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $411 | $411 | $411 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $171 | $171 | $171 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $271 | $409 | $547 |
| Septoplasty CPT 30520 • ENT | $1,252 | $1,252 | $1,252 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $404 | $404 | $404 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $346 | $346 | $346 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $470 | $470 | $470 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $812 | $812 | $812 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $596 | $596 | $596 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $165 | $165 | $165 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $488 | $488 | $488 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $695 | $695 | $695 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $174 | $264 | $354 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $535 | $535 | $535 |
| Tonsillectomy primary under age 12 CPT 42826 • ENT | $469 | $469 | $469 |
| Adenoidectomy primary under age 12 CPT 42830 • ENT | $389 | $389 | $389 |
| Removal impacted cerumen unilateral CPT 69210 • ENT | $87 | $87 | $87 |
| Tympanostomy tube insertion CPT 69436 • ENT | $138 | $215 | $292 |
| Tympanoplasty with mastoidectomy CPT 69633 • ENT | $937 | $1,444 | $1,950 |
| Comprehensive audiometry evaluation CPT 92557 • ENT | $35 | $35 | $35 |
| Incision and drainage abscess simple CPT 10060 • Emergency | $172 | $172 | $172 |
| Incision and drainage abscess complicated CPT 10061 • Emergency | $295 | $343 | $391 |
| Simple wound repair up to 2.5cm CPT 12001 • Emergency | $130 | $151 | $172 |