| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $12 | $12 | $12 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $10 | $10 | $10 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $48 | $48 | $48 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $44 | $44 | $44 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $15 | $15 | $15 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $44 | $44 | $44 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $60 | $60 | $60 |
| 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 | $80 | $80 | $80 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $101 | $101 | $101 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $18 | $18 | $18 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $93 | $93 | $93 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $23 | $23 | $23 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $113 | $113 | $113 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $9 | $9 | $9 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $12 | $12 | $12 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $1 | $1 | $1 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $44 | $44 | $44 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $45 | $45 | $45 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $73 | $73 | $73 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $124 | $124 | $124 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $31 | $31 | $31 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $7 | $7 | $7 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $3 | $3 | $3 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $49 | $49 | $49 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $5 | $5 | $5 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $361 | $361 | $361 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $12 | $12 | $12 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $5 | $5 | $5 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $642 | $642 | $642 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $535 | $535 | $535 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $192 | $192 | $192 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $1,585 | $1,585 | $1,585 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $32 | $32 | $32 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $50 | $50 | $50 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $32 | $32 | $32 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $35 | $35 | $35 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $51 | $51 | $51 |
| Septoplasty CPT 30520 • ENT | $538 | $538 | $538 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $38 | $38 | $38 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $7 | $7 | $7 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $26 | $26 | $26 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $262 | $262 | $262 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $174 | $174 | $174 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $19 | $19 | $19 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $44 | $44 | $44 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $61 | $61 | $61 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $151 | $151 | $151 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $220 | $220 | $220 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $328 | $328 | $328 |