| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $143 | $143 | $143 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $129 | $129 | $129 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $53 | $53 | $53 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $69 | $80 | $91 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $3 | $5 | $7 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $405 | $405 | $405 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $115 | $134 | $154 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $86 | $86 | $86 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $112 | $112 | $112 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $50 | $50 | $50 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $6 | $6 | $6 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $3 | $3 | $3 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $15 | $15 | $15 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $12 | $12 | $12 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $96 | $96 | $96 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $12 | $12 | $12 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $37 | $37 | $37 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $420 | $420 | $420 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $322 | $322 | $322 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $977 | $977 | $977 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $699 | $699 | $699 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $291 | $291 | $291 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $724 | $724 | $724 |
| Septoplasty CPT 30520 • ENT | $809 | $809 | $809 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $658 | $658 | $658 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $236 | $236 | $236 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $314 | $314 | $314 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $657 | $657 | $657 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $904 | $904 | $904 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $535 | $535 | $535 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $341 | $341 | $341 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $1,056 | $1,056 | $1,056 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $554 | $554 | $554 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $813 | $813 | $813 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $424 | $424 | $424 |
| Tonsillectomy primary under age 12 CPT 42826 • ENT | $705 | $705 | $705 |
| Adenoidectomy primary under age 12 CPT 42830 • ENT | $298 | $298 | $298 |
| Removal impacted cerumen unilateral CPT 69210 • ENT | $41 | $53 | $65 |
| Tympanostomy tube insertion CPT 69436 • ENT | $446 | $446 | $446 |
| Tympanoplasty without mastoidectomy CPT 69631 • ENT | $2,460 | $2,460 | $2,460 |
| Tympanoplasty with mastoidectomy CPT 69633 • ENT | $2,908 | $2,908 | $2,908 |
| Comprehensive audiometry evaluation CPT 92557 • ENT | $42 | $42 | $42 |
| Incision and drainage abscess simple CPT 10060 • Emergency | $170 | $270 | $371 |
| Incision and drainage abscess complicated CPT 10061 • Emergency | $197 | $197 | $197 |
| Simple wound repair up to 2.5cm CPT 12001 • Emergency | $51 | $51 | $51 |
| Simple wound repair 2.6-7.5cm CPT 12002 • Emergency | $67 | $67 | $67 |
| Simple wound repair face 2.5cm or less CPT 12011 • Emergency | $127 | $127 | $127 |
| Intermediate wound repair 2.5cm or less CPT 12031 • Emergency | $158 | $158 | $158 |
| Intermediate wound repair face 2.5cm or less CPT 12051 • Emergency | $756 | $756 | $756 |
| Initial treatment first degree burn CPT 16000 • Emergency | $57 | $57 | $57 |