| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $159 | $159 | $159 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $72 | $72 | $72 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $128 | $128 | $128 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $155 | $155 | $155 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $48 | $48 | $48 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $148 | $148 | $148 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $162 | $162 | $162 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $198 | $198 | $198 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $218 | $218 | $218 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $182 | $182 | $182 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $250 | $250 | $250 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $290 | $290 | $290 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $310 | $310 | $310 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $257 | $257 | $257 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $146 | $146 | $146 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $85 | $85 | $85 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $3 | $3 | $3 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $126 | $126 | $126 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $85 | $85 | $85 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $168 | $168 | $168 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $144 | $144 | $144 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $195 | $195 | $195 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $3 | $3 | $3 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $1 | $1 | $1 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $40 | $40 | $40 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $4 | $4 | $4 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $38 | $38 | $38 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $10 | $10 | $10 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $4 | $4 | $4 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $50 | $50 | $50 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $440 | $440 | $440 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $15 | $15 | $15 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $1,104 | $1,104 | $1,104 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $160 | $160 | $160 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $419 | $419 | $419 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $348 | $348 | $348 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $145 | $145 | $145 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $227 | $398 | $455 |
| Septoplasty CPT 30520 • ENT | $865 | $981 | $1,040 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $150 | $254 | $334 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $239 | $275 | $287 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $203 | $345 | $392 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $559 | $634 | $671 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $412 | $474 | $495 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $229 | $264 | $276 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $259 | $352 | $406 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $481 | $554 | $578 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $132 | $224 | $295 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $373 | $429 | $448 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $30 | $340 | $469 |