| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $112 | $112 | $112 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $137 | $137 | $137 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $89 | $89 | $89 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $107 | $107 | $107 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $93 | $93 | $93 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $102 | $102 | $102 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $111 | $111 | $111 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $135 | $135 | $135 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $149 | $149 | $149 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $124 | $124 | $124 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $173 | $173 | $173 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $199 | $199 | $199 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $213 | $213 | $213 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $178 | $178 | $178 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $97 | $97 | $97 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $56 | $56 | $56 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $142 | $142 | $142 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $97 | $97 | $97 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $114 | $114 | $114 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $110 | $110 | $110 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $150 | $150 | $150 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $6 | $6 | $6 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $2 | $2 | $2 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $38 | $38 | $38 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $32 | $32 | $32 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $414 | $414 | $414 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $107 | $107 | $107 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $76 | $76 | $76 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $555 | $555 | $555 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $4,840 | $4,840 | $4,840 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $163 | $163 | $163 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $1,823 | $1,823 | $1,823 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $199 | $199 | $199 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $568 | $568 | $568 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $433 | $433 | $433 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $180 | $180 | $180 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $326 | $326 | $326 |
| Septoplasty CPT 30520 • ENT | $741 | $741 | $741 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $250 | $250 | $250 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $217 | $217 | $217 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $281 | $281 | $281 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $483 | $483 | $483 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $350 | $350 | $350 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $195 | $195 | $195 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $286 | $286 | $286 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $409 | $409 | $409 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $194 | $194 | $194 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $286 | $286 | $286 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $299 | $299 | $299 |
| Tonsillectomy primary under age 12 CPT 42826 • ENT | $250 | $250 | $250 |