| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $111 | $194 | $276 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $99 | $110 | $121 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $66 | $67 | $69 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $9 | $10 | $12 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $222 | $225 | $227 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $86 | $92 | $99 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $114 | $146 | $178 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $39 | $81 | $123 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $46 | $96 | $146 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $7 | $7 | $7 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $15 | $15 | $15 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $13 | $13 | $13 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $12 | $12 | $12 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $1,042 | $1,042 | $1,042 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $311 | $311 | $311 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $426 | $434 | $443 |
| Septoplasty CPT 30520 • ENT | $553 | $681 | $809 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $133 | $231 | $328 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $68 | $131 | $195 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $326 | $344 | $362 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $313 | $328 | $344 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $415 | $463 | $510 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $232 | $240 | $248 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $341 | $371 | $402 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $483 | $564 | $644 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $149 | $224 | $299 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $325 | $360 | $395 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $352 | $382 | $412 |
| Tonsillectomy primary under age 12 CPT 42826 • ENT | $289 | $319 | $350 |
| Adenoidectomy primary under age 12 CPT 42830 • ENT | $230 | $263 | $295 |
| Removal impacted cerumen unilateral CPT 69210 • ENT | $43 | $49 | $56 |
| Tympanostomy tube insertion CPT 69436 • ENT | $191 | $205 | $219 |
| Tympanoplasty without mastoidectomy CPT 69631 • ENT | $942 | $1,074 | $1,206 |
| Tympanoplasty with mastoidectomy CPT 69633 • ENT | $1,127 | $1,274 | $1,422 |
| Comprehensive audiometry evaluation CPT 92557 • ENT | $42 | $45 | $49 |
| Incision and drainage abscess simple CPT 10060 • Emergency | $108 | $136 | $164 |
| Incision and drainage abscess complicated CPT 10061 • Emergency | $193 | $237 | $280 |
| Simple wound repair up to 2.5cm CPT 12001 • Emergency | $58 | $86 | $114 |
| Simple wound repair 2.6-7.5cm CPT 12002 • Emergency | $75 | $101 | $128 |
| Simple wound repair face 2.5cm or less CPT 12011 • Emergency | $118 | $150 | $182 |
| Intermediate wound repair 2.5cm or less CPT 12031 • Emergency | $177 | $188 | $199 |
| Intermediate wound repair face 2.5cm or less CPT 12051 • Emergency | $198 | $227 | $256 |
| Initial treatment first degree burn CPT 16000 • Emergency | $54 | $66 | $79 |
| Emergency department visit self-limited problem CPT 99281 • Emergency | $17 | $18 | $18 |
| Emergency department visit low severity CPT 99282 • Emergency | $29 | $47 | $64 |
| Emergency department visit moderate severity CPT 99283 • Emergency | $66 | $88 | $110 |
| Emergency department visit high severity CPT 99284 • Emergency | $103 | $145 | $186 |
| Emergency department visit highest severity CPT 99285 • Emergency | $161 | $216 | $271 |
| Critical care first 30-74 minutes CPT 99291 • Emergency | $221 | $268 | $316 |
| Critical care each additional 30 minutes CPT 99292 • Emergency | $111 | $135 | $159 |