| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $219 | $219 | $219 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $265 | $265 | $265 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $173 | $173 | $173 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $213 | $213 | $213 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $175 | $175 | $175 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $87 | $87 | $87 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $219 | $219 | $219 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $265 | $265 | $265 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $295 | $295 | $295 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $184 | $184 | $184 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $341 | $341 | $341 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $272 | $272 | $272 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $442 | $442 | $442 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $228 | $228 | $228 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $185 | $185 | $185 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $118 | $118 | $118 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $10 | $10 | $10 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $267 | $267 | $267 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $195 | $195 | $195 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $232 | $232 | $232 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $123 | $123 | $123 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $273 | $273 | $273 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $14 | $14 | $14 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $6 | $6 | $6 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $26 | $26 | $26 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $86 | $86 | $86 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $112 | $112 | $112 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $66 | $66 | $66 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $10 | $10 | $10 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $132 | $132 | $132 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $1,199 | $1,199 | $1,199 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $42 | $42 | $42 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $502 | $502 | $502 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $630 | $630 | $630 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $1,999 | $1,999 | $1,999 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $930 | $930 | $930 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $517 | $517 | $517 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $779 | $779 | $779 |
| Septoplasty CPT 30520 • ENT | $1,112 | $1,112 | $1,112 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $242 | $242 | $242 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $367 | $367 | $367 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $460 | $460 | $460 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $500 | $500 | $500 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $733 | $733 | $733 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $362 | $362 | $362 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $581 | $581 | $581 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $925 | $925 | $925 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $341 | $341 | $341 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $529 | $529 | $529 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $551 | $551 | $551 |