| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $185 | $185 | $185 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $224 | $224 | $224 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $51 | $51 | $51 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $177 | $177 | $177 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $146 | $146 | $146 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $168 | $168 | $168 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $118 | $118 | $118 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $219 | $219 | $219 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $243 | $243 | $243 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $199 | $199 | $199 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $283 | $283 | $283 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $217 | $217 | $217 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $365 | $365 | $365 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $295 | $295 | $295 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $144 | $144 | $144 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $98 | $98 | $98 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $8 | $8 | $8 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $146 | $146 | $146 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $103 | $103 | $103 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $194 | $194 | $194 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $94 | $94 | $94 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $82 | $82 | $82 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $21 | $21 | $21 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $6 | $6 | $6 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $51 | $51 | $51 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $8 | $8 | $8 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $60 | $60 | $60 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $15 | $15 | $15 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $7 | $7 | $7 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $78 | $78 | $78 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $704 | $704 | $704 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $25 | $25 | $25 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $1,750 | $1,750 | $1,750 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $204 | $204 | $204 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $600 | $600 | $600 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $378 | $378 | $378 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $175 | $175 | $175 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $659 | $659 | $659 |
| Septoplasty CPT 30520 • ENT | $919 | $919 | $919 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $204 | $204 | $204 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $94 | $94 | $94 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $383 | $383 | $383 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $396 | $396 | $396 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $579 | $579 | $579 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $287 | $287 | $287 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $460 | $460 | $460 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $731 | $731 | $731 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $203 | $203 | $203 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $429 | $429 | $429 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $446 | $446 | $446 |