| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $48 | $48 | $48 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $59 | $59 | $59 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $90 | $90 | $90 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $111 | $111 | $111 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $39 | $39 | $39 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $108 | $108 | $108 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $116 | $116 | $116 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $141 | $141 | $141 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $110 | $110 | $110 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $128 | $128 | $128 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $182 | $182 | $182 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $215 | $215 | $215 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $233 | $233 | $233 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $189 | $189 | $189 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $104 | $104 | $104 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $51 | $51 | $51 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $5 | $5 | $5 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $94 | $94 | $94 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $102 | $102 | $102 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $122 | $122 | $122 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $104 | $104 | $104 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $149 | $149 | $149 |
| 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 | $11 | $11 | $11 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $5 | $5 | $5 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $61 | $61 | $61 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $12 | $12 | $12 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $6 | $6 | $6 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $81 | $81 | $81 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $551 | $551 | $551 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $25 | $25 | $25 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $213 | $213 | $213 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $256 | $256 | $256 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $622 | $719 | $815 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $452 | $452 | $452 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $188 | $188 | $188 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $189 | $189 | $189 |
| Septoplasty CPT 30520 • ENT | $609 | $609 | $609 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $218 | $218 | $218 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $67 | $67 | $67 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $260 | $260 | $260 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $432 | $432 | $432 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $345 | $345 | $345 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $180 | $180 | $180 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $282 | $282 | $282 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $402 | $402 | $402 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $192 | $192 | $192 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $297 | $297 | $297 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $310 | $310 | $310 |