| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $172 | $172 | $172 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $209 | $209 | $209 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $49 | $49 | $49 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $134 | $134 | $134 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $99 | $99 | $99 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $115 | $115 | $115 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $175 | $175 | $175 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $212 | $212 | $212 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $163 | $163 | $163 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $200 | $200 | $200 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $151 | $151 | $151 |
| 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 | $299 | $299 | $299 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $286 | $286 | $286 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $138 | $138 | $138 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $97 | $97 | $97 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $6 | $6 | $6 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $246 | $246 | $246 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $138 | $138 | $138 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $189 | $189 | $189 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $97 | $97 | $97 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $182 | $182 | $182 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $40 | $40 | $40 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $14 | $14 | $14 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $17 | $17 | $17 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $20 | $20 | $20 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $176 | $176 | $176 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $39 | $39 | $39 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $17 | $17 | $17 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $251 | $251 | $251 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $1,589 | $1,589 | $1,589 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $57 | $57 | $57 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $559 | $559 | $559 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $330 | $330 | $330 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $989 | $989 | $989 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $613 | $613 | $613 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $309 | $309 | $309 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $645 | $645 | $645 |
| Septoplasty CPT 30520 • ENT | $905 | $905 | $905 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $200 | $200 | $200 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $131 | $131 | $131 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $263 | $263 | $263 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $512 | $512 | $512 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $581 | $581 | $581 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $287 | $287 | $287 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $461 | $461 | $461 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $963 | $963 | $963 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $282 | $282 | $282 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $427 | $427 | $427 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $602 | $602 | $602 |