| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $132 | $132 | $132 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $161 | $161 | $161 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $147 | $147 | $147 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $203 | $203 | $203 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $252 | $252 | $253 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $209 | $209 | $209 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $42 | $67 | $93 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $56 | $63 | $71 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $0 | $0 | $0 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $172 | $172 | $172 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $117 | $117 | $118 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $137 | $137 | $138 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $132 | $132 | $133 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $158 | $158 | $158 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $3 | $3 | $3 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $1 | $1 | $1 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $9 | $28 | $46 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $27 | $27 | $27 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $373 | $373 | $373 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $111 | $111 | $111 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $26 | $30 | $35 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $49 | $271 | $492 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $3,665 | $3,665 | $3,665 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $101 | $118 | $135 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $1,249 | $1,457 | $1,665 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $233 | $233 | $233 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $383 | $383 | $384 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $214 | $214 | $214 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $354 | $354 | $354 |
| Septoplasty CPT 30520 • ENT | $804 | $804 | $804 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $229 | $229 | $229 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $317 | $317 | $317 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $523 | $523 | $523 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $377 | $377 | $378 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $212 | $212 | $212 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $310 | $310 | $310 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $441 | $441 | $441 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $198 | $198 | $198 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $300 | $300 | $301 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $314 | $314 | $314 |
| Tonsillectomy primary under age 12 CPT 42826 • ENT | $265 | $265 | $265 |
| Adenoidectomy primary under age 12 CPT 42830 • ENT | $222 | $222 | $222 |
| Tympanostomy tube insertion CPT 69436 • ENT | $168 | $168 | $168 |
| Tympanoplasty without mastoidectomy CPT 69631 • ENT | $925 | $925 | $925 |
| Tympanoplasty with mastoidectomy CPT 69633 • ENT | $1,094 | $1,094 | $1,095 |
| Comprehensive audiometry evaluation CPT 92557 • ENT | $40 | $40 | $40 |
| Incision and drainage abscess simple CPT 10060 • Emergency | $131 | $131 | $132 |
| Incision and drainage abscess complicated CPT 10061 • Emergency | $220 | $220 | $220 |
| Simple wound repair up to 2.5cm CPT 12001 • Emergency | $4 | $4 | $4 |
| Simple wound repair face 2.5cm or less CPT 12011 • Emergency | $115 | $115 | $115 |