| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $102 | $133 | $163 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $156 | $156 | $156 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $147 | $156 | $166 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $81 | $142 | $202 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $225 | $225 | $225 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $167 | $167 | $167 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $114 | $114 | $114 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $167 | $195 | $209 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $42 | $42 | $42 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $44 | $44 | $44 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $8 | $8 | $8 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $44 | $126 | $209 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $95 | $122 | $150 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $87 | $100 | $112 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $108 | $108 | $108 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $145 | $145 | $145 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $5 | $5 | $5 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $2 | $2 | $2 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $11 | $36 | $61 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $31 | $31 | $31 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $373 | $373 | $373 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $115 | $115 | $115 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $34 | $34 | $34 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $49 | $49 | $49 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $4,274 | $4,274 | $4,274 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $26 | $26 | $26 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $2,155 | $2,559 | $2,962 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $291 | $291 | $291 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $411 | $411 | $411 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $171 | $187 | $203 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $271 | $278 | $286 |
| Septoplasty CPT 30520 • ENT | $657 | $657 | $657 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $263 | $263 | $263 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $178 | $178 | $178 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $248 | $248 | $248 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $421 | $421 | $421 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $318 | $318 | $318 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $165 | $165 | $165 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $44 | $44 | $44 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $174 | $174 | $174 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $289 | $289 | $289 |
| Tonsillectomy primary under age 12 CPT 42826 • ENT | $253 | $346 | $439 |
| Adenoidectomy primary under age 12 CPT 42830 • ENT | $210 | $210 | $210 |
| Removal impacted cerumen unilateral CPT 69210 • ENT | $95 | $95 | $95 |
| Tympanostomy tube insertion CPT 69436 • ENT | $142 | $144 | $147 |
| Tympanoplasty with mastoidectomy CPT 69633 • ENT | $937 | $952 | $967 |
| Comprehensive audiometry evaluation CPT 92557 • ENT | $34 | $50 | $67 |
| Incision and drainage abscess simple CPT 10060 • Emergency | $108 | $123 | $137 |
| Incision and drainage abscess complicated CPT 10061 • Emergency | $249 | $249 | $249 |
| Simple wound repair up to 2.5cm CPT 12001 • Emergency | $78 | $78 | $78 |