| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $39 | $39 | $39 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $47 | $47 | $47 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $21 | $21 | $21 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $55 | $55 | $55 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $27 | $27 | $27 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $52 | $52 | $52 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $82 | $82 | $82 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $94 | $94 | $94 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $107 | $107 | $107 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $93 | $93 | $93 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $108 | $108 | $108 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $124 | $124 | $124 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $93 | $93 | $93 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $109 | $109 | $109 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $46 | $46 | $46 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $46 | $46 | $46 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $8 | $8 | $8 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $116 | $116 | $116 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $66 | $66 | $66 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $42 | $42 | $42 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $47 | $47 | $47 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $121 | $121 | $121 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $31 | $31 | $31 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $8 | $8 | $8 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $62 | $62 | $62 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $90 | $90 | $90 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $114 | $114 | $114 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $29 | $29 | $29 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $13 | $13 | $13 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $183 | $183 | $183 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $1,373 | $1,373 | $1,373 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $44 | $44 | $44 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $316 | $316 | $316 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $229 | $229 | $229 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $791 | $791 | $791 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $426 | $426 | $426 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $197 | $197 | $197 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $301 | $301 | $301 |
| Septoplasty CPT 30520 • ENT | $437 | $437 | $437 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $135 | $135 | $135 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $115 | $115 | $115 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $232 | $232 | $232 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $281 | $281 | $281 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $419 | $419 | $419 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $200 | $200 | $200 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $329 | $329 | $329 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $531 | $531 | $531 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $182 | $182 | $182 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $308 | $308 | $308 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $322 | $322 | $322 |