| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $180 | $288 | $365 |
| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $180 | $288 | $365 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $320 | $415 | $559 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $180 | $303 | $365 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $180 | $303 | $365 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $180 | $303 | $365 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $180 | $303 | $365 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $32 | $319 | $559 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $107 | $131 | $180 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $118 | $284 | $559 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $32 | $207 | $559 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $320 | $415 | $559 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $32 | $207 | $559 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $180 | $265 | $365 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $365 | $430 | $559 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $180 | $273 | $320 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $180 | $273 | $320 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $180 | $273 | $320 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $180 | $273 | $320 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $180 | $288 | $365 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $180 | $288 | $365 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $101 | $101 | $101 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $141 | $290 | $365 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $4 | $4 | $4 |
| 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 | $29 | $29 | $29 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $39 | $39 | $39 |
| 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 | $51 | $51 | $51 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $437 | $437 | $437 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $14 | $14 | $14 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $1,154 | $1,154 | $1,154 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $174 | $174 | $174 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $525 | $525 | $525 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $285 | $285 | $285 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $141 | $141 | $141 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $365 | $890 | $1,906 |
| Septoplasty CPT 30520 • ENT | $549 | $1,001 | $1,906 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $365 | $791 | $1,642 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $180 | $327 | $400 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $400 | $814 | $1,642 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $549 | $1,001 | $1,906 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $365 | $1,338 | $3,000 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $470 | $949 | $1,906 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $470 | $949 | $1,906 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $365 | $1,243 | $3,000 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $180 | $273 | $320 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $365 | $914 | $1,906 |