| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $123 | $123 | $123 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $98 | $98 | $98 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $53 | $53 | $53 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $7 | $7 | $7 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $176 | $176 | $176 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $115 | $115 | $115 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $135 | $135 | $135 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $46 | $46 | $46 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $176 | $176 | $176 |
| 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 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $24 | $24 | $24 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $12 | $12 | $12 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $133 | $133 | $133 |
| 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 | $311 | $311 | $311 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $443 | $443 | $443 |
| Septoplasty CPT 30520 • ENT | $614 | $614 | $614 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $133 | $133 | $133 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $59 | $59 | $59 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $197 | $197 | $197 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $398 | $398 | $398 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $296 | $296 | $296 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $244 | $244 | $244 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $351 | $351 | $351 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $560 | $560 | $560 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $175 | $175 | $175 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $329 | $329 | $329 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $321 | $321 | $321 |
| Tonsillectomy primary under age 12 CPT 42826 • ENT | $350 | $350 | $350 |
| Adenoidectomy primary under age 12 CPT 42830 • ENT | $199 | $199 | $199 |
| Removal impacted cerumen unilateral CPT 69210 • ENT | $55 | $55 | $55 |
| Tympanostomy tube insertion CPT 69436 • ENT | $219 | $219 | $219 |
| Tympanoplasty without mastoidectomy CPT 69631 • ENT | $809 | $809 | $809 |
| Tympanoplasty with mastoidectomy CPT 69633 • ENT | $1,070 | $1,070 | $1,070 |
| Comprehensive audiometry evaluation CPT 92557 • ENT | $53 | $53 | $53 |
| Incision and drainage abscess simple CPT 10060 • Emergency | $94 | $94 | $94 |
| Incision and drainage abscess complicated CPT 10061 • Emergency | $197 | $197 | $197 |
| Simple wound repair up to 2.5cm CPT 12001 • Emergency | $133 | $133 | $133 |
| Simple wound repair 2.6-7.5cm CPT 12002 • Emergency | $67 | $67 | $67 |
| Simple wound repair face 2.5cm or less CPT 12011 • Emergency | $53 | $53 | $53 |
| Intermediate wound repair 2.5cm or less CPT 12031 • Emergency | $158 | $158 | $158 |
| Intermediate wound repair face 2.5cm or less CPT 12051 • Emergency | $262 | $262 | $262 |