| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $183 | $183 | $183 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $81 | $81 | $81 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $32 | $32 | $32 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $101 | $101 | $101 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $79 | $79 | $79 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $47 | $47 | $47 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $144 | $144 | $144 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $110 | $110 | $110 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $185 | $185 | $185 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $162 | $162 | $162 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $212 | $212 | $212 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $243 | $243 | $243 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $261 | $261 | $261 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $131 | $131 | $131 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $109 | $109 | $109 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $58 | $58 | $58 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $9 | $9 | $9 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $160 | $160 | $160 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $69 | $69 | $69 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $140 | $140 | $140 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $64 | $64 | $64 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $182 | $182 | $182 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $30 | $30 | $30 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $9 | $9 | $9 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $47 | $47 | $47 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $96 | $96 | $96 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $112 | $112 | $112 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $25 | $25 | $25 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $13 | $13 | $13 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $159 | $159 | $159 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $1,373 | $1,373 | $1,373 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $43 | $43 | $43 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $3,159 | $3,159 | $3,159 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $310 | $310 | $310 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $862 | $862 | $862 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $499 | $499 | $499 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $206 | $206 | $206 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $630 | $630 | $630 |
| Septoplasty CPT 30520 • ENT | $840 | $840 | $840 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $348 | $348 | $348 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $296 | $296 | $296 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $514 | $514 | $514 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $429 | $429 | $429 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $634 | $634 | $634 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $312 | $312 | $312 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $500 | $500 | $500 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $797 | $797 | $797 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $236 | $236 | $236 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $375 | $375 | $375 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $395 | $395 | $395 |