| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $225 | $225 | $225 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $280 | $280 | $280 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $5 | $84 | $181 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $47 | $114 | $219 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $27 | $95 | $189 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $68 | $118 | $209 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $73 | $112 | $153 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $42 | $149 | $282 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $21 | $173 | $311 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $119 | $161 | $194 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $65 | $149 | $221 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $33 | $183 | $267 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $35 | $269 | $442 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $110 | $192 | $239 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $46 | $112 | $207 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $32 | $74 | $122 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $10 | $13 | $16 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $19 | $144 | $237 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $38 | $104 | $206 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $6 | $111 | $240 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $18 | $110 | $193 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $64 | $110 | $155 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $3 | $3 | $3 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $1 | $1 | $1 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $27 | $27 | $27 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $21 | $21 | $21 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $280 | $280 | $280 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $82 | $82 | $82 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $23 | $23 | $23 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $36 | $36 | $36 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $283 | $283 | $283 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $73 | $73 | $73 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $827 | $827 | $827 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $163 | $163 | $163 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $154 | $154 | $154 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $268 | $268 | $268 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $132 | $132 | $132 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $297 | $423 | $616 |
| Septoplasty CPT 30520 • ENT | $230 | $779 | $1,428 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $111 | $154 | $219 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $32 | $222 | $445 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $93 | $383 | $897 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $43 | $523 | $1,088 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $213 | $719 | $1,625 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $155 | $370 | $775 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $264 | $625 | $1,278 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $80 | $840 | $2,063 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $124 | $165 | $194 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $54 | $306 | $569 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $220 | $380 | $611 |