| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $75 | $75 | $75 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $224 | $224 | $224 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $141 | $141 | $141 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $174 | $174 | $174 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $145 | $145 | $145 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $165 | $165 | $165 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $118 | $141 | $163 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $217 | $217 | $217 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $169 | $169 | $169 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $199 | $199 | $199 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $282 | $282 | $282 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $221 | $221 | $221 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $362 | $362 | $362 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $187 | $187 | $187 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $74 | $110 | $147 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $110 | $110 | $110 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $15 | $15 | $15 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $219 | $219 | $219 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $103 | $140 | $178 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $190 | $190 | $190 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $102 | $102 | $102 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $99 | $99 | $99 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $21 | $21 | $21 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $6 | $6 | $6 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $10 | $73 | $136 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $63 | $116 | $169 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $79 | $79 | $79 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $18 | $18 | $18 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $11 | $11 | $11 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $107 | $107 | $107 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $971 | $971 | $971 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $35 | $35 | $35 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $2,276 | $2,276 | $2,276 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $202 | $370 | $539 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $593 | $749 | $906 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $374 | $374 | $374 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $173 | $367 | $464 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $660 | $660 | $660 |
| Septoplasty CPT 30520 • ENT | $937 | $937 | $937 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $342 | $342 | $342 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $97 | $97 | $97 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $386 | $386 | $386 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $412 | $412 | $412 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $604 | $604 | $604 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $298 | $298 | $298 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $479 | $479 | $479 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $762 | $762 | $762 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $290 | $290 | $290 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $442 | $442 | $442 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $459 | $459 | $459 |