| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $110 | $117 | $125 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $90 | $121 | $153 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $149 | $149 | $149 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $140 | $140 | $140 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $171 | $182 | $193 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $42 | $127 | $211 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $198 | $198 | $198 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $79 | $79 | $79 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $47 | $56 | $65 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $0 | $0 | $0 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $163 | $163 | $164 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $109 | $109 | $110 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $114 | $114 | $114 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $112 | $112 | $112 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $149 | $149 | $149 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $5 | $5 | $5 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $2 | $3 | $3 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $12 | $42 | $73 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $53 | $53 | $53 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $690 | $690 | $690 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $178 | $178 | $178 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $7 | $42 | $77 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $927 | $927 | $927 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $5,868 | $5,868 | $5,868 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $27 | $149 | $270 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $2,197 | $2,238 | $2,280 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $206 | $206 | $206 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $800 | $800 | $800 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $177 | $177 | $178 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $285 | $288 | $291 |
| Septoplasty CPT 30520 • ENT | $652 | $652 | $652 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $30 | $30 | $30 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $180 | $182 | $184 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $245 | $248 | $250 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $423 | $423 | $423 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $310 | $314 | $317 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $172 | $172 | $172 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $254 | $257 | $259 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $369 | $369 | $370 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $25 | $25 | $25 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $270 | $277 | $285 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $297 | $297 | $297 |
| Tonsillectomy primary under age 12 CPT 42826 • ENT | $236 | $236 | $236 |
| Adenoidectomy primary under age 12 CPT 42830 • ENT | $206 | $206 | $207 |
| Removal impacted cerumen unilateral CPT 69210 • ENT | $41 | $41 | $41 |
| Tympanostomy tube insertion CPT 69436 • ENT | $141 | $148 | $155 |
| Tympanoplasty without mastoidectomy CPT 69631 • ENT | $877 | $877 | $877 |
| Tympanoplasty with mastoidectomy CPT 69633 • ENT | $943 | $943 | $944 |
| Comprehensive audiometry evaluation CPT 92557 • ENT | $36 | $36 | $36 |
| Incision and drainage abscess simple CPT 10060 • Emergency | $107 | $114 | $121 |