| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $112 | $112 | $112 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $123 | $123 | $123 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $85 | $109 | $133 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $155 | $159 | $162 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $179 | $179 | $179 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $142 | $146 | $149 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $240 | $240 | $240 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $257 | $257 | $257 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $213 | $213 | $213 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $42 | $67 | $92 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $66 | $67 | $68 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $6 | $7 | $7 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $161 | $166 | $171 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $109 | $113 | $117 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $137 | $137 | $137 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $148 | $148 | $148 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $6 | $6 | $6 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $2 | $2 | $2 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $11 | $44 | $78 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $96 | $96 | $96 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $22 | $22 | $22 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $11 | $11 | $11 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $121 | $121 | $121 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $1,030 | $1,030 | $1,030 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $37 | $37 | $37 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $529 | $753 | $977 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $611 | $611 | $611 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $285 | $285 | $285 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $306 | $306 | $306 |
| Septoplasty CPT 30520 • ENT | $635 | $635 | $635 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $234 | $234 | $234 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $270 | $270 | $270 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $353 | $353 | $353 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $575 | $575 | $575 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $269 | $269 | $269 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $151 | $151 | $151 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $221 | $221 | $221 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $313 | $313 | $313 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $209 | $209 | $209 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $264 | $264 | $264 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $276 | $276 | $276 |
| Tonsillectomy primary under age 12 CPT 42826 • ENT | $236 | $236 | $236 |
| Adenoidectomy primary under age 12 CPT 42830 • ENT | $200 | $200 | $200 |
| Removal impacted cerumen unilateral CPT 69210 • ENT | $52 | $56 | $59 |
| Tympanostomy tube insertion CPT 69436 • ENT | $148 | $148 | $148 |
| Tympanoplasty without mastoidectomy CPT 69631 • ENT | $1,843 | $1,843 | $1,843 |
| Tympanoplasty with mastoidectomy CPT 69633 • ENT | $2,180 | $2,180 | $2,180 |
| Comprehensive audiometry evaluation CPT 92557 • ENT | $31 | $34 | $37 |
| Incision and drainage abscess simple CPT 10060 • Emergency | $92 | $110 | $128 |
| Incision and drainage abscess complicated CPT 10061 • Emergency | $149 | $185 | $220 |