| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $228 | $229 | $230 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $116 | $116 | $116 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $50 | $50 | $50 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $1 | $1 | $1 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $91 | $91 | $91 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $106 | $106 | $106 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $123 | $124 | $125 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $108 | $108 | $108 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $147 | $147 | $147 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $7 | $7 | $7 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $2 | $3 | $3 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $67 | $90 | $114 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $64 | $64 | $64 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $809 | $809 | $809 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $214 | $214 | $214 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $90 | $90 | $90 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $823 | $823 | $823 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $9,245 | $9,245 | $9,245 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $32 | $32 | $32 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $362 | $1,989 | $3,617 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $268 | $268 | $268 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $445 | $445 | $445 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $240 | $242 | $245 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $276 | $276 | $276 |
| Septoplasty CPT 30520 • ENT | $631 | $631 | $631 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $142 | $142 | $142 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $175 | $175 | $175 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $238 | $238 | $238 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $408 | $408 | $408 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $296 | $296 | $296 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $168 | $168 | $168 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $243 | $243 | $243 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $176 | $176 | $176 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $270 | $270 | $270 |
| Tonsillectomy primary under age 12 CPT 42826 • ENT | $237 | $237 | $237 |
| Adenoidectomy primary under age 12 CPT 42830 • ENT | $197 | $197 | $197 |
| Tympanostomy tube insertion CPT 69436 • ENT | $148 | $152 | $156 |
| Tympanoplasty with mastoidectomy CPT 69633 • ENT | $980 | $998 | $1,015 |
| Comprehensive audiometry evaluation CPT 92557 • ENT | $35 | $35 | $35 |
| Incision and drainage abscess simple CPT 10060 • Emergency | $117 | $117 | $117 |
| Simple wound repair 2.6-7.5cm CPT 12002 • Emergency | $52 | $52 | $52 |
| Simple wound repair face 2.5cm or less CPT 12011 • Emergency | $103 | $103 | $103 |
| Intermediate wound repair 2.5cm or less CPT 12031 • Emergency | $244 | $244 | $244 |
| Intermediate wound repair face 2.5cm or less CPT 12051 • Emergency | $263 | $264 | $264 |
| Initial treatment first degree burn CPT 16000 • Emergency | $75 | $75 | $75 |
| Emergency department visit self-limited problem CPT 99281 • Emergency | $10 | $10 | $10 |
| Emergency department visit low severity CPT 99282 • Emergency | $31 | $31 | $31 |
| Emergency department visit moderate severity CPT 99283 • Emergency | $62 | $62 | $62 |
| Emergency department visit high severity CPT 99284 • Emergency | $79 | $92 | $105 |
| Emergency department visit highest severity CPT 99285 • Emergency | $153 | $153 | $153 |