| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $49 | $49 | $49 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $143 | $143 | $143 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $34 | $34 | $34 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $111 | $111 | $111 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $93 | $93 | $93 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $106 | $106 | $106 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $115 | $115 | $115 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $99 | $99 | $99 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $155 | $155 | $155 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $127 | $127 | $127 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $181 | $181 | $181 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $215 | $215 | $215 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $233 | $233 | $233 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $189 | $189 | $189 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $95 | $95 | $95 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $71 | $71 | $71 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $9 | $9 | $9 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $96 | $96 | $96 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $103 | $103 | $103 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $122 | $122 | $122 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $64 | $64 | $64 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $145 | $145 | $145 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $19 | $19 | $19 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $6 | $6 | $6 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $49 | $49 | $49 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $43 | $43 | $43 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $79 | $79 | $79 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $18 | $18 | $18 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $11 | $11 | $11 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $107 | $107 | $107 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $971 | $971 | $971 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $30 | $30 | $30 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $2,276 | $2,276 | $2,276 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $198 | $198 | $198 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $774 | $774 | $774 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $429 | $429 | $429 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $179 | $179 | $179 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $423 | $423 | $423 |
| Septoplasty CPT 30520 • ENT | $605 | $605 | $605 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $218 | $218 | $218 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $199 | $199 | $199 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $249 | $249 | $249 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $269 | $269 | $269 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $394 | $394 | $394 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $195 | $195 | $195 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $313 | $313 | $313 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $498 | $498 | $498 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $186 | $186 | $186 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $287 | $287 | $287 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $298 | $298 | $298 |