| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $181 | $181 | $181 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $33 | $33 | $33 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $56 | $56 | $56 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $68 | $68 | $68 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $81 | $81 | $81 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $124 | $124 | $124 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $102 | $102 | $102 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $118 | $118 | $118 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $143 | $143 | $143 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $103 | $103 | $103 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $199 | $199 | $199 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $145 | $145 | $145 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $111 | $111 | $111 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $99 | $99 | $99 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $69 | $69 | $69 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $12 | $12 | $12 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $198 | $198 | $198 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $99 | $99 | $99 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $77 | $77 | $77 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $39 | $39 | $39 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $70 | $70 | $70 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $10 | $10 | $10 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $4 | $4 | $4 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $33 | $33 | $33 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $44 | $44 | $44 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $512 | $512 | $512 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $143 | $143 | $143 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $56 | $56 | $56 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $896 | $896 | $896 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $6,331 | $6,331 | $6,331 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $232 | $232 | $232 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $2,226 | $2,226 | $2,226 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $426 | $426 | $426 |
| Septoplasty CPT 30520 • ENT | $553 | $553 | $553 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $133 | $133 | $133 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $90 | $90 | $90 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $223 | $223 | $223 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $344 | $344 | $344 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $510 | $510 | $510 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $248 | $248 | $248 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $402 | $402 | $402 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $644 | $644 | $644 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $149 | $149 | $149 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $325 | $325 | $325 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $352 | $352 | $352 |
| Tonsillectomy primary under age 12 CPT 42826 • ENT | $289 | $289 | $289 |
| Adenoidectomy primary under age 12 CPT 42830 • ENT | $230 | $230 | $230 |
| Removal impacted cerumen unilateral CPT 69210 • ENT | $39 | $39 | $39 |
| Tympanostomy tube insertion CPT 69436 • ENT | $191 | $191 | $191 |
| Tympanoplasty without mastoidectomy CPT 69631 • ENT | $942 | $942 | $942 |