| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $209 | $209 | $209 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $254 | $254 | $254 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $92 | $92 | $92 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $123 | $123 | $123 |
| 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 | $174 | $174 | $174 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $148 | $148 | $148 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $236 | $236 | $236 |
| 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 | $243 | $243 | $243 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $281 | $281 | $281 |
| 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 | $247 | $247 | $247 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $146 | $146 | $146 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $97 | $97 | $97 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $15 | $15 | $15 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $286 | $286 | $286 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $87 | $87 | $87 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $159 | $159 | $159 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $49 | $49 | $49 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $91 | $91 | $91 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $46 | $46 | $46 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $14 | $14 | $14 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $82 | $82 | $82 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $27 | $27 | $27 |
| 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 | $20 | $20 | $20 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $251 | $251 | $251 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $2,146 | $2,146 | $2,146 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $67 | $67 | $67 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $4,936 | $4,936 | $4,936 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $358 | $358 | $358 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $1,236 | $1,236 | $1,236 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $665 | $665 | $665 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $309 | $309 | $309 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $607 | $607 | $607 |
| Septoplasty CPT 30520 • ENT | $794 | $794 | $794 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $310 | $310 | $310 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $269 | $269 | $269 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $514 | $514 | $514 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $512 | $512 | $512 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $763 | $763 | $763 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $370 | $370 | $370 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $600 | $600 | $600 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $963 | $963 | $963 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $313 | $313 | $313 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $554 | $554 | $554 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $602 | $602 | $602 |