| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $53 | $53 | $53 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $64 | $64 | $64 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $101 | $101 | $101 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $122 | $122 | $122 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $105 | $105 | $105 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $52 | $52 | $52 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $129 | $129 | $129 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $157 | $157 | $157 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $173 | $173 | $173 |
| 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 | $198 | $198 | $198 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $170 | $170 | $170 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $185 | $185 | $185 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $204 | $204 | $204 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $61 | $61 | $61 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $68 | $68 | $68 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $7 | $7 | $7 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $168 | $168 | $168 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $79 | $79 | $79 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $96 | $96 | $96 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $136 | $136 | $136 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $389 | $389 | $389 |
| 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 | $27 | $27 | $27 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $21 | $21 | $21 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $210 | $210 | $210 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $82 | $82 | $82 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $2 | $2 | $2 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $364 | $364 | $364 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $283 | $283 | $283 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $73 | $73 | $73 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $827 | $827 | $827 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $163 | $163 | $163 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $154 | $154 | $154 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $268 | $268 | $268 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $132 | $132 | $132 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $297 | $297 | $297 |
| Septoplasty CPT 30520 • ENT | $680 | $680 | $680 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $219 | $219 | $219 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $187 | $187 | $187 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $258 | $258 | $258 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $278 | $278 | $278 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $321 | $321 | $321 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $179 | $179 | $179 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $303 | $303 | $303 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $375 | $375 | $375 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $194 | $194 | $194 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $295 | $295 | $295 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $308 | $308 | $308 |