| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $97 | $97 | $97 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $108 | $116 | $124 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $133 | $133 | $133 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $121 | $121 | $121 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $168 | $180 | $193 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $208 | $223 | $237 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $78 | $90 | $102 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $58 | $58 | $58 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $0 | $1 | $2 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $142 | $142 | $142 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $96 | $102 | $109 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $112 | $120 | $128 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $108 | $110 | $112 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $152 | $152 | $152 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $8 | $8 | $8 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $2 | $3 | $3 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $13 | $31 | $49 |
| 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 | $40 | $58 | $76 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $516 | $722 | $927 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $807 | $807 | $807 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $27 | $90 | $154 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $1,788 | $2,034 | $2,280 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $368 | $368 | $368 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $446 | $622 | $799 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $203 | $268 | $333 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $286 | $289 | $291 |
| Septoplasty CPT 30520 • ENT | $665 | $665 | $665 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $178 | $181 | $183 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $249 | $249 | $250 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $431 | $431 | $431 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $317 | $318 | $319 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $177 | $177 | $177 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $259 | $260 | $262 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $369 | $371 | $373 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $131 | $159 | $186 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $284 | $287 | $289 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $302 | $302 | $302 |
| Tonsillectomy primary under age 12 CPT 42826 • ENT | $249 | $249 | $249 |
| Adenoidectomy primary under age 12 CPT 42830 • ENT | $206 | $208 | $210 |
| Removal impacted cerumen unilateral CPT 69210 • ENT | $30 | $30 | $30 |
| Tympanostomy tube insertion CPT 69436 • ENT | $148 | $151 | $155 |
| Tympanoplasty without mastoidectomy CPT 69631 • ENT | $817 | $847 | $877 |
| Tympanoplasty with mastoidectomy CPT 69633 • ENT | $967 | $1,002 | $1,037 |
| Comprehensive audiometry evaluation CPT 92557 • ENT | $36 | $36 | $36 |
| Incision and drainage abscess simple CPT 10060 • Emergency | $108 | $115 | $121 |
| Incision and drainage abscess complicated CPT 10061 • Emergency | $184 | $184 | $184 |
| Simple wound repair up to 2.5cm CPT 12001 • Emergency | $80 | $80 | $80 |