| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $104 | $104 | $104 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $38 | $38 | $38 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $83 | $83 | $83 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $34 | $34 | $34 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $87 | $87 | $87 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $30 | $30 | $30 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $65 | $65 | $65 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $133 | $133 | $133 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $146 | $146 | $146 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $122 | $122 | $122 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $91 | $91 | $91 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $107 | $107 | $107 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $205 | $205 | $205 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $173 | $173 | $173 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $95 | $95 | $95 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $57 | $57 | $57 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $5 | $5 | $5 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $69 | $69 | $69 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $96 | $96 | $96 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $112 | $112 | $112 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $101 | $101 | $101 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $119 | $119 | $119 |
| 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 | $66 | $66 | $66 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $26 | $26 | $26 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $45 | $45 | $45 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $13 | $13 | $13 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $4 | $4 | $4 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $58 | $58 | $58 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $500 | $500 | $500 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $129 | $129 | $129 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $1,312 | $1,312 | $1,312 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $263 | $263 | $263 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $486 | $486 | $486 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $488 | $488 | $488 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $226 | $226 | $226 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $250 | $250 | $250 |
| Septoplasty CPT 30520 • ENT | $519 | $519 | $519 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $190 | $190 | $190 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $167 | $167 | $167 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $227 | $227 | $227 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $372 | $372 | $372 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $223 | $223 | $223 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $125 | $125 | $125 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $183 | $183 | $183 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $259 | $259 | $259 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $170 | $170 | $170 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $217 | $217 | $217 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $226 | $226 | $226 |