| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $9 | $9 | $9 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $76 | $76 | $76 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $75 | $75 | $75 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $10 | $10 | $10 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $10 | $10 | $10 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $22 | $22 | $22 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $12 | $12 | $12 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $15 | $15 | $15 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $17 | $17 | $17 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $30 | $30 | $30 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $17 | $17 | $17 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $223 | $223 | $223 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $30 | $30 | $30 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $12 | $12 | $12 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $6 | $6 | $6 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $53 | $53 | $53 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $30 | $30 | $30 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $33 | $33 | $33 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $30 | $30 | $30 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $13 | $13 | $13 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $112 | $112 | $112 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $15 | $15 | $15 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $8 | $8 | $8 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $3 | $3 | $3 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $73 | $73 | $73 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $8 | $8 | $8 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $518 | $518 | $518 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $134 | $134 | $134 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $77 | $77 | $77 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $927 | $927 | $927 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $8,072 | $8,072 | $8,072 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $203 | $203 | $203 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $2,281 | $2,281 | $2,281 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $184 | $184 | $184 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $203 | $203 | $203 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $160 | $160 | $160 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $50 | $50 | $50 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $218 | $218 | $218 |
| Septoplasty CPT 30520 • ENT | $100 | $100 | $100 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $108 | $108 | $108 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $47 | $47 | $47 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $188 | $188 | $188 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $432 | $432 | $432 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $48 | $48 | $48 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $132 | $132 | $132 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $259 | $259 | $259 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $185 | $185 | $185 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $188 | $188 | $188 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $285 | $285 | $285 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $30 | $30 | $30 |