| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $67 | $67 | $67 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $67 | $67 | $67 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $113 | $113 | $113 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $137 | $137 | $137 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $54 | $54 | $54 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $64 | $64 | $64 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $142 | $142 | $142 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $118 | $118 | $118 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $230 | $230 | $230 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $189 | $189 | $189 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $165 | $165 | $165 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $311 | $311 | $311 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $334 | $334 | $334 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $229 | $229 | $229 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $125 | $125 | $125 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $61 | $61 | $61 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $7 | $7 | $7 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $213 | $213 | $213 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $76 | $76 | $76 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $177 | $177 | $177 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $124 | $124 | $124 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $71 | $71 | $71 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $4 | $4 | $4 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $2 | $2 | $2 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $29 | $29 | $29 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $59 | $59 | $59 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $78 | $78 | $78 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $10 | $10 | $10 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $4 | $4 | $4 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $51 | $51 | $51 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $437 | $437 | $437 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $14 | $14 | $14 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $1,154 | $1,154 | $1,154 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $174 | $174 | $174 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $525 | $525 | $525 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $570 | $570 | $570 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $281 | $281 | $281 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $321 | $321 | $321 |
| Septoplasty CPT 30520 • ENT | $732 | $732 | $732 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $294 | $294 | $294 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $261 | $261 | $261 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $286 | $286 | $286 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $476 | $476 | $476 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $370 | $370 | $370 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $205 | $205 | $205 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $363 | $363 | $363 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $431 | $431 | $431 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $217 | $217 | $217 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $328 | $328 | $328 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $342 | $342 | $342 |