| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $41 | $53 | $65 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $136 | $136 | $136 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $149 | $149 | $149 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $66 | $125 | $183 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $73 | $137 | $202 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $41 | $41 | $41 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $41 | $41 | $41 |
| 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 | $41 | $41 | $41 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $41 | $41 | $41 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $57 | $68 | $78 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $6 | $7 | $8 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $41 | $41 | $41 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $41 | $58 | $75 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $41 | $76 | $112 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $73 | $73 | $73 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $177 | $177 | $177 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $33 | $33 | $33 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $44 | $44 | $44 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $13 | $13 | $13 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $60 | $60 | $60 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $251 | $251 | $251 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $791 | $791 | $791 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $411 | $411 | $411 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $203 | $203 | $203 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $415 | $415 | $415 |
| Septoplasty CPT 30520 • ENT | $558 | $567 | $575 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $219 | $219 | $219 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $41 | $49 | $58 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $309 | $319 | $329 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $251 | $251 | $251 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $41 | $41 | $41 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $41 | $41 | $41 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $291 | $291 | $291 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $463 | $463 | $463 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $187 | $187 | $187 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $41 | $41 | $41 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $292 | $292 | $292 |
| Tonsillectomy primary under age 12 CPT 42826 • ENT | $244 | $244 | $244 |
| Adenoidectomy primary under age 12 CPT 42830 • ENT | $202 | $202 | $202 |
| Removal impacted cerumen unilateral CPT 69210 • ENT | $35 | $45 | $55 |
| Tympanostomy tube insertion CPT 69436 • ENT | $154 | $180 | $206 |
| Tympanoplasty without mastoidectomy CPT 69631 • ENT | $41 | $41 | $41 |
| Comprehensive audiometry evaluation CPT 92557 • ENT | $34 | $34 | $35 |
| Incision and drainage abscess simple CPT 10060 • Emergency | $94 | $119 | $145 |
| Incision and drainage abscess complicated CPT 10061 • Emergency | $178 | $214 | $249 |
| Simple wound repair up to 2.5cm CPT 12001 • Emergency | $41 | $57 | $72 |
| Simple wound repair 2.6-7.5cm CPT 12002 • Emergency | $63 | $63 | $63 |
| Simple wound repair face 2.5cm or less CPT 12011 • Emergency | $108 | $108 | $108 |
| Intermediate wound repair 2.5cm or less CPT 12031 • Emergency | $41 | $132 | $223 |