| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $20 | $20 | $20 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $98 | $98 | $98 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $31 | $31 | $31 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $85 | $85 | $85 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $15 | $15 | $15 |
| 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 | $10 | $10 | $10 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $12 | $12 | $12 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $42 | $42 | $42 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $14 | $14 | $14 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $9 | $9 | $9 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $127 | $127 | $127 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $98 | $98 | $98 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $83 | $83 | $83 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $34 | $34 | $34 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $5 | $5 | $5 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $4 | $4 | $4 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $22 | $22 | $22 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $30 | $30 | $30 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $51 | $51 | $51 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $15 | $15 | $15 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $14 | $14 | $14 |
| 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 | $12 | $12 | $12 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $26 | $26 | $26 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $397 | $397 | $397 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $123 | $123 | $123 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $6 | $6 | $6 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $536 | $536 | $536 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $496 | $496 | $496 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $208 | $208 | $208 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $1,730 | $1,730 | $1,730 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $18 | $18 | $18 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $90 | $90 | $90 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $164 | $164 | $164 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $17 | $17 | $17 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $245 | $245 | $245 |
| Septoplasty CPT 30520 • ENT | $74 | $74 | $74 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $86 | $86 | $86 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $14 | $14 | $14 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $169 | $169 | $169 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $358 | $358 | $358 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $341 | $341 | $341 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $161 | $161 | $161 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $42 | $42 | $42 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $526 | $526 | $526 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $64 | $64 | $64 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $153 | $153 | $153 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $199 | $199 | $199 |