| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $139 | $139 | $139 |
| 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 | $61 | $61 | $61 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $82 | $82 | $82 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $37 | $37 | $37 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $75 | $75 | $75 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $108 | $108 | $108 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $91 | $91 | $91 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $146 | $146 | $146 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $90 | $90 | $90 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $163 | $163 | $163 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $129 | $129 | $129 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $139 | $139 | $139 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $109 | $109 | $109 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $93 | $93 | $93 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $48 | $48 | $48 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $5 | $5 | $5 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $126 | $126 | $126 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $91 | $91 | $91 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $110 | $110 | $110 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $60 | $60 | $60 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $157 | $157 | $157 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $22 | $22 | $22 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $6 | $6 | $6 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $44 | $44 | $44 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $68 | $68 | $68 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $84 | $84 | $84 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $19 | $19 | $19 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $10 | $10 | $10 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $120 | $120 | $120 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $1,030 | $1,030 | $1,030 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $28 | $28 | $28 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $2,369 | $2,369 | $2,369 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $181 | $181 | $181 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $774 | $774 | $774 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $392 | $392 | $392 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $163 | $163 | $163 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $397 | $397 | $397 |
| Septoplasty CPT 30520 • ENT | $546 | $546 | $546 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $205 | $205 | $205 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $177 | $177 | $177 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $183 | $183 | $183 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $281 | $281 | $281 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $418 | $418 | $418 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $204 | $204 | $204 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $329 | $329 | $329 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $526 | $526 | $526 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $172 | $172 | $172 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $280 | $280 | $280 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $295 | $295 | $295 |