| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $26 | $26 | $26 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $104 | $104 | $104 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $66 | $66 | $66 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $80 | $80 | $80 |
| 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 | $77 | $77 | $77 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $52 | $52 | $52 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $106 | $106 | $106 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $70 | $70 | $70 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $97 | $97 | $97 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $136 | $136 | $136 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $156 | $156 | $156 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $165 | $165 | $165 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $139 | $139 | $139 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $33 | $33 | $33 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $46 | $46 | $46 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $4 | $4 | $4 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $111 | $111 | $111 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $76 | $76 | $76 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $89 | $89 | $89 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $78 | $78 | $78 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $94 | $94 | $94 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $5 | $5 | $5 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $2 | $2 | $2 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $66 | $66 | $66 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $4 | $4 | $4 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $310 | $310 | $310 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $88 | $88 | $88 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $26 | $26 | $26 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $538 | $538 | $538 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $529 | $529 | $529 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $108 | $108 | $108 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $1,401 | $1,401 | $1,401 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $263 | $263 | $263 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $554 | $554 | $554 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $488 | $488 | $488 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $226 | $226 | $226 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $201 | $201 | $201 |
| Septoplasty CPT 30520 • ENT | $418 | $418 | $418 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $150 | $150 | $150 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $132 | $132 | $132 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $182 | $182 | $182 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $298 | $298 | $298 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $185 | $185 | $185 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $103 | $103 | $103 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $152 | $152 | $152 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $215 | $215 | $215 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $87 | $87 | $87 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $177 | $177 | $177 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $185 | $185 | $185 |