| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $46 | $46 | $46 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $135 | $135 | $135 |
| 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 | $65 | $65 | $65 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $51 | $51 | $51 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $61 | $61 | $61 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $93 | $93 | $93 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $109 | $109 | $109 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $124 | $124 | $124 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $107 | $107 | $107 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $130 | $130 | $130 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $149 | $149 | $149 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $158 | $158 | $158 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $83 | $83 | $83 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $74 | $74 | $74 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $52 | $52 | $52 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $9 | $9 | $9 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $170 | $170 | $170 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $45 | $45 | $45 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $85 | $85 | $85 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $32 | $32 | $32 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $57 | $57 | $57 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $23 | $23 | $23 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $8 | $8 | $8 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $39 | $39 | $39 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $74 | $74 | $74 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $98 | $98 | $98 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $21 | $21 | $21 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $11 | $11 | $11 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $140 | $140 | $140 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $1,202 | $1,202 | $1,202 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $33 | $33 | $33 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $2,764 | $2,764 | $2,764 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $197 | $197 | $197 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $904 | $904 | $904 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $427 | $427 | $427 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $178 | $178 | $178 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $319 | $319 | $319 |
| Septoplasty CPT 30520 • ENT | $414 | $414 | $414 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $169 | $169 | $169 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $146 | $146 | $146 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $271 | $271 | $271 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $258 | $258 | $258 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $382 | $382 | $382 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $186 | $186 | $186 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $301 | $301 | $301 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $483 | $483 | $483 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $142 | $142 | $142 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $243 | $243 | $243 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $264 | $264 | $264 |