| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $99 | $99 | $99 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $120 | $120 | $120 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $78 | $78 | $78 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $97 | $97 | $97 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $80 | $80 | $80 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $91 | $91 | $91 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $99 | $99 | $99 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $119 | $119 | $119 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $133 | $133 | $133 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $108 | $108 | $108 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $154 | $154 | $154 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $183 | $183 | $183 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $199 | $199 | $199 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $102 | $102 | $102 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $46 | $46 | $46 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $54 | $54 | $54 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $4 | $4 | $4 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $120 | $120 | $120 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $57 | $57 | $57 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $105 | $105 | $105 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $56 | $56 | $56 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $126 | $126 | $126 |
| 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 | $9 | $9 | $9 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $30 | $30 | $30 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $39 | $39 | $39 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $23 | $23 | $23 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $4 | $4 | $4 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $46 | $46 | $46 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $422 | $422 | $422 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $15 | $15 | $15 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $1,179 | $1,179 | $1,179 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $260 | $260 | $260 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $746 | $746 | $746 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $397 | $397 | $397 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $181 | $181 | $181 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $352 | $352 | $352 |
| Septoplasty CPT 30520 • ENT | $500 | $500 | $500 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $182 | $182 | $182 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $167 | $167 | $167 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $207 | $207 | $207 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $222 | $222 | $222 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $326 | $326 | $326 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $161 | $161 | $161 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $258 | $258 | $258 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $411 | $411 | $411 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $154 | $154 | $154 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $236 | $236 | $236 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $246 | $246 | $246 |