| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $192 | $192 | $192 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $233 | $233 | $233 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $84 | $84 | $84 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $110 | $110 | $110 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $88 | $88 | $88 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $103 | $103 | $103 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $159 | $159 | $159 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $187 | $187 | $187 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $214 | $214 | $214 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $183 | $183 | $183 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $222 | $222 | $222 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $255 | $255 | $255 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $270 | $270 | $270 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $226 | $226 | $226 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $25 | $77 | $129 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $88 | $88 | $88 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $15 | $15 | $15 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $289 | $289 | $289 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $77 | $102 | $127 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $145 | $145 | $145 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $55 | $55 | $55 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $202 | $202 | $202 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $24 | $24 | $24 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $7 | $7 | $7 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $47 | $47 | $47 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $14 | $14 | $14 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $91 | $91 | $91 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $21 | $21 | $21 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $10 | $10 | $10 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $130 | $130 | $130 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $1,116 | $1,116 | $1,116 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $30 | $30 | $30 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $2,567 | $2,567 | $2,567 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $183 | $183 | $183 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $839 | $839 | $839 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $397 | $397 | $397 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $165 | $165 | $165 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $549 | $549 | $549 |
| Septoplasty CPT 30520 • ENT | $711 | $711 | $711 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $288 | $288 | $288 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $249 | $249 | $249 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $466 | $466 | $466 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $448 | $448 | $448 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $667 | $667 | $667 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $323 | $323 | $323 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $525 | $525 | $525 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $841 | $841 | $841 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $243 | $243 | $243 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $419 | $419 | $419 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $455 | $455 | $455 |