| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $128 | $128 | $128 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $368 | $368 | $368 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $239 | $239 | $239 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $296 | $296 | $296 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $243 | $243 | $243 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $122 | $122 | $122 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $304 | $304 | $304 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $262 | $262 | $262 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $410 | $410 | $410 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $330 | $330 | $330 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $303 | $303 | $303 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $379 | $379 | $379 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $614 | $614 | $614 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $317 | $317 | $317 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $259 | $259 | $259 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $164 | $164 | $164 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $14 | $14 | $14 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $253 | $253 | $253 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $271 | $271 | $271 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $323 | $323 | $323 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $204 | $204 | $204 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $206 | $206 | $206 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $5 | $5 | $5 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $2 | $2 | $2 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $11 | $11 | $11 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $23 | $23 | $23 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $39 | $39 | $39 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $23 | $23 | $23 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $4 | $4 | $4 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $46 | $46 | $46 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $422 | $422 | $422 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $15 | $15 | $15 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $1,179 | $1,179 | $1,179 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $260 | $260 | $260 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $746 | $746 | $746 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $397 | $397 | $397 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $181 | $181 | $181 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $1,081 | $1,081 | $1,081 |
| Septoplasty CPT 30520 • ENT | $1,548 | $1,548 | $1,548 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $336 | $336 | $336 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $166 | $166 | $166 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $639 | $639 | $639 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $699 | $699 | $699 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $1,025 | $1,025 | $1,025 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $505 | $505 | $505 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $812 | $812 | $812 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $1,293 | $1,293 | $1,293 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $477 | $477 | $477 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $744 | $744 | $744 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $776 | $776 | $776 |