| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $15 | $64 | $114 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $100 | $112 | $125 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $81 | $117 | $153 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $57 | $57 | $57 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $75 | $107 | $140 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $154 | $174 | $193 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $77 | $77 | $77 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $125 | $182 | $238 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $159 | $159 | $159 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $38 | $58 | $79 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $18 | $42 | $65 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $0 | $1 | $2 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $77 | $120 | $164 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $36 | $73 | $110 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $44 | $86 | $129 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $62 | $87 | $112 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $81 | $81 | $81 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $3 | $3 | $3 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $73 | $73 | $73 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $77 | $77 | $77 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $927 | $927 | $927 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $270 | $270 | $270 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $3,041 | $3,041 | $3,041 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $800 | $800 | $800 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $333 | $333 | $333 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $58 | $175 | $291 |
| Septoplasty CPT 30520 • ENT | $353 | $353 | $353 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $50 | $50 | $50 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $21 | $103 | $184 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $84 | $167 | $250 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $125 | $125 | $125 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $105 | $211 | $317 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $59 | $117 | $175 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $86 | $173 | $259 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $195 | $282 | $370 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $71 | $130 | $188 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $230 | $257 | $285 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $160 | $229 | $297 |
| Tonsillectomy primary under age 12 CPT 42826 • ENT | $85 | $85 | $85 |
| Adenoidectomy primary under age 12 CPT 42830 • ENT | $168 | $188 | $207 |
| Removal impacted cerumen unilateral CPT 69210 • ENT | $37 | $37 | $37 |
| Tympanostomy tube insertion CPT 69436 • ENT | $84 | $120 | $156 |
| Tympanoplasty without mastoidectomy CPT 69631 • ENT | $697 | $787 | $877 |
| Tympanoplasty with mastoidectomy CPT 69633 • ENT | $346 | $692 | $1,037 |
| Comprehensive audiometry evaluation CPT 92557 • ENT | $16 | $16 | $16 |
| Incision and drainage abscess simple CPT 10060 • Emergency | $84 | $102 | $121 |
| Incision and drainage abscess complicated CPT 10061 • Emergency | $144 | $176 | $208 |
| Simple wound repair up to 2.5cm CPT 12001 • Emergency | $74 | $83 | $91 |
| Simple wound repair 2.6-7.5cm CPT 12002 • Emergency | $89 | $89 | $89 |
| Simple wound repair face 2.5cm or less CPT 12011 • Emergency | $88 | $88 | $88 |