| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $113 | $113 | $113 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $136 | $136 | $136 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $38 | $38 | $38 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $81 | $81 | $81 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $60 | $60 | $60 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $74 | $74 | $74 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $104 | $104 | $104 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $126 | $126 | $126 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $140 | $140 | $140 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $114 | $114 | $114 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $30 | $30 | $30 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $195 | $195 | $195 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $213 | $213 | $213 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $30 | $30 | $30 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $38 | $38 | $38 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $38 | $38 | $38 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $38 | $38 | $38 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $150 | $150 | $150 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $38 | $38 | $38 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $115 | $115 | $115 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $77 | $77 | $77 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $189 | $189 | $189 |
| 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 | $73 | $73 | $73 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $53 | $53 | $53 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $690 | $690 | $690 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $178 | $178 | $178 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $76 | $76 | $76 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $927 | $927 | $927 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $807 | $807 | $807 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $270 | $270 | $270 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $3,041 | $3,041 | $3,041 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $251 | $251 | $251 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $791 | $791 | $791 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $799 | $799 | $799 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $203 | $203 | $203 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $429 | $429 | $429 |
| Septoplasty CPT 30520 • ENT | $601 | $601 | $601 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $225 | $225 | $225 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $190 | $190 | $190 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $321 | $321 | $321 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $30 | $30 | $30 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $391 | $391 | $391 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $193 | $193 | $193 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $310 | $310 | $310 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $492 | $492 | $492 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $173 | $173 | $173 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $264 | $264 | $264 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $275 | $275 | $275 |