| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $7 | $7 | $7 |
| 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 | $22 | $22 | $22 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $54 | $54 | $54 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $4 | $4 | $4 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $14 | $14 | $14 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $30 | $30 | $30 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $20 | $20 | $20 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $11 | $11 | $11 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $70 | $70 | $70 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $118 | $118 | $118 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $108 | $108 | $108 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $109 | $109 | $109 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $99 | $99 | $99 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $48 | $48 | $48 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $37 | $37 | $37 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $7 | $7 | $7 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $106 | $106 | $106 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $30 | $30 | $30 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $20 | $20 | $20 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $56 | $56 | $56 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $6 | $6 | $6 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $6 | $6 | $6 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $3 | $3 | $3 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $55 | $55 | $55 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $61 | $61 | $61 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $51 | $51 | $51 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $134 | $134 | $134 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $6 | $6 | $6 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $695 | $695 | $695 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $807 | $807 | $807 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $203 | $203 | $203 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $2,519 | $2,519 | $2,519 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $369 | $369 | $369 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $152 | $152 | $152 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $44 | $44 | $44 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $67 | $67 | $67 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $122 | $122 | $122 |
| Septoplasty CPT 30520 • ENT | $107 | $107 | $107 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $32 | $32 | $32 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $6 | $6 | $6 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $16 | $16 | $16 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $432 | $432 | $432 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $63 | $63 | $63 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $28 | $28 | $28 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $28 | $28 | $28 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $74 | $74 | $74 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $188 | $188 | $188 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $57 | $57 | $57 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $61 | $61 | $61 |