| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $15 | $15 | $15 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $23 | $23 | $23 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $19 | $19 | $19 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $22 | $22 | $22 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $21 | $21 | $21 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $9 | $9 | $9 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $71 | $71 | $71 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $107 | $107 | $107 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $67 | $67 | $67 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $87 | $87 | $87 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $145 | $145 | $145 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $95 | $95 | $95 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $69 | $69 | $69 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $92 | $92 | $92 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $16 | $16 | $16 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $49 | $49 | $49 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $0 | $0 | $0 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $82 | $82 | $82 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $110 | $110 | $110 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $59 | $59 | $59 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $22 | $22 | $22 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $113 | $113 | $113 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $8 | $8 | $8 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $3 | $3 | $3 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $55 | $55 | $55 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $61 | $61 | $61 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $69 | $69 | $69 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $18 | $18 | $18 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $57 | $57 | $57 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $417 | $417 | $417 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $8,072 | $8,072 | $8,072 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $122 | $122 | $122 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $304 | $304 | $304 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $200 | $200 | $200 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $1,015 | $1,015 | $1,015 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $800 | $800 | $800 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $167 | $167 | $167 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $97 | $97 | $97 |
| Septoplasty CPT 30520 • ENT | $666 | $666 | $666 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $113 | $113 | $113 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $28 | $28 | $28 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $141 | $141 | $141 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $216 | $216 | $216 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $350 | $350 | $350 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $195 | $195 | $195 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $215 | $215 | $215 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $41 | $41 | $41 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $97 | $97 | $97 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $142 | $142 | $142 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $45 | $45 | $45 |