| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $78 | $78 | $78 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $68 | $68 | $68 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $54 | $54 | $54 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $70 | $70 | $70 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $84 | $84 | $84 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $124 | $124 | $124 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $102 | $127 | $152 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $163 | $165 | $167 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $140 | $140 | $140 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $115 | $115 | $115 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $216 | $216 | $216 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $233 | $233 | $233 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $123 | $123 | $123 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $78 | $89 | $100 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $65 | $70 | $75 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $8 | $19 | $30 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $148 | $148 | $148 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $102 | $106 | $109 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $122 | $125 | $128 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $47 | $47 | $47 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $62 | $62 | $62 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $8 | $8 | $8 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $3 | $3 | $3 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $73 | $73 | $73 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $53 | $53 | $53 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $690 | $690 | $690 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $178 | $178 | $178 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $76 | $76 | $76 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $927 | $927 | $927 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $8,071 | $8,071 | $8,071 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $270 | $270 | $270 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $3,041 | $3,041 | $3,041 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $291 | $362 | $433 |
| Septoplasty CPT 30520 • ENT | $605 | $635 | $665 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $229 | $229 | $229 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $86 | $135 | $183 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $210 | $210 | $210 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $323 | $323 | $323 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $479 | $479 | $479 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $234 | $234 | $234 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $378 | $378 | $378 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $604 | $604 | $604 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $146 | $146 | $146 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $323 | $323 | $323 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $339 | $339 | $339 |
| Tonsillectomy primary under age 12 CPT 42826 • ENT | $279 | $279 | $279 |
| Adenoidectomy primary under age 12 CPT 42830 • ENT | $225 | $225 | $225 |
| Removal impacted cerumen unilateral CPT 69210 • ENT | $46 | $50 | $54 |
| Tympanostomy tube insertion CPT 69436 • ENT | $155 | $169 | $184 |
| Tympanoplasty without mastoidectomy CPT 69631 • ENT | $930 | $930 | $930 |