| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $330 | $330 | $330 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $399 | $399 | $399 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $263 | $263 | $263 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $135 | $135 | $135 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $276 | $276 | $276 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $304 | $304 | $304 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $331 | $331 | $331 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $402 | $402 | $402 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $447 | $447 | $447 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $366 | $366 | $366 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $519 | $519 | $519 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $601 | $601 | $601 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $646 | $646 | $646 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $533 | $533 | $533 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $140 | $140 | $140 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $140 | $140 | $140 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $16 | $16 | $16 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $253 | $253 | $253 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $294 | $294 | $294 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $343 | $343 | $343 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $263 | $263 | $263 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $360 | $360 | $360 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $10 | $10 | $10 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $4 | $4 | $4 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $80 | $80 | $80 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $76 | $76 | $76 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $94 | $94 | $94 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $23 | $23 | $23 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $10 | $10 | $10 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $121 | $121 | $121 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $1,095 | $1,095 | $1,095 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $36 | $36 | $36 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $2,732 | $2,732 | $2,732 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $450 | $450 | $450 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $1,243 | $1,243 | $1,243 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $899 | $899 | $899 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $363 | $363 | $363 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $689 | $689 | $689 |
| Septoplasty CPT 30520 • ENT | $1,571 | $1,571 | $1,571 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $531 | $531 | $531 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $470 | $470 | $470 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $614 | $614 | $614 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $588 | $588 | $588 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $785 | $785 | $785 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $436 | $436 | $436 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $641 | $641 | $641 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $915 | $915 | $915 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $472 | $472 | $472 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $705 | $705 | $705 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $737 | $737 | $737 |