| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $79 | $102 | $125 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $41 | $97 | $153 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $106 | $123 | $140 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $190 | $192 | $193 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $41 | $41 | $41 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $234 | $234 | $234 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $21 | $21 | $21 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $79 | $79 | $79 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $65 | $65 | $65 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $0 | $1 | $2 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $164 | $164 | $164 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $108 | $109 | $110 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $126 | $126 | $127 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $112 | $122 | $131 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $175 | $175 | $175 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $8 | $8 | $8 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $3 | $3 | $3 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $54 | $54 | $54 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $46 | $46 | $46 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $512 | $512 | $512 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $148 | $148 | $148 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $58 | $67 | $77 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $927 | $927 | $927 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $6,380 | $6,380 | $6,380 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $270 | $270 | $270 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $304 | $1,414 | $2,524 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $210 | $210 | $210 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $269 | $269 | $269 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $411 | $605 | $800 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $145 | $145 | $146 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $291 | $310 | $328 |
| Septoplasty CPT 30520 • ENT | $752 | $752 | $752 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $184 | $195 | $207 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $250 | $266 | $282 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $487 | $487 | $487 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $317 | $337 | $357 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $197 | $197 | $197 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $41 | $150 | $259 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $41 | $205 | $370 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $21 | $21 | $21 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $285 | $295 | $305 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $297 | $297 | $297 |
| Tonsillectomy primary under age 12 CPT 42826 • ENT | $268 | $268 | $268 |
| Adenoidectomy primary under age 12 CPT 42830 • ENT | $207 | $214 | $222 |
| Removal impacted cerumen unilateral CPT 69210 • ENT | $21 | $21 | $21 |
| Tympanostomy tube insertion CPT 69436 • ENT | $163 | $163 | $164 |
| Tympanoplasty without mastoidectomy CPT 69631 • ENT | $877 | $877 | $877 |
| Tympanoplasty with mastoidectomy CPT 69633 • ENT | $1,093 | $1,093 | $1,094 |
| Comprehensive audiometry evaluation CPT 92557 • ENT | $42 | $42 | $42 |
| Incision and drainage abscess simple CPT 10060 • Emergency | $119 | $120 | $121 |