| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $108 | $108 | $108 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $131 | $131 | $131 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $53 | $53 | $53 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $72 | $72 | $72 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $54 | $54 | $54 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $65 | $65 | $65 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $90 | $90 | $90 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $110 | $110 | $110 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $122 | $122 | $122 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $99 | $99 | $99 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $137 | $137 | $137 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $169 | $169 | $169 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $186 | $186 | $186 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $147 | $147 | $147 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $76 | $76 | $76 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $61 | $61 | $61 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $33 | $33 | $33 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $135 | $135 | $135 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $86 | $86 | $86 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $101 | $101 | $101 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $75 | $75 | $75 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $185 | $185 | $185 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $21 | $21 | $21 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $6 | $6 | $6 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $38 | $38 | $38 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $55 | $55 | $55 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $643 | $643 | $643 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $145 | $145 | $145 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $85 | $85 | $85 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $889 | $889 | $889 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $7,860 | $7,860 | $7,860 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $278 | $278 | $278 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $1,842 | $1,842 | $1,842 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $155 | $155 | $155 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $447 | $447 | $447 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $310 | $310 | $310 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $125 | $125 | $125 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $355 | $355 | $355 |
| Septoplasty CPT 30520 • ENT | $491 | $491 | $491 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $184 | $184 | $184 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $158 | $158 | $158 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $272 | $272 | $272 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $232 | $232 | $232 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $417 | $417 | $417 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $169 | $169 | $169 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $329 | $329 | $329 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $526 | $526 | $526 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $171 | $171 | $171 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $268 | $268 | $268 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $280 | $280 | $280 |