| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $39 | $39 | $39 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $47 | $47 | $47 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $28 | $28 | $28 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $62 | $62 | $62 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $78 | $78 | $78 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $53 | $53 | $53 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $138 | $138 | $138 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $115 | $115 | $115 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $128 | $128 | $128 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $104 | $104 | $104 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $208 | $208 | $208 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $167 | $167 | $167 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $260 | $260 | $260 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $98 | $98 | $98 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $113 | $113 | $113 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $49 | $49 | $49 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $9 | $9 | $9 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $118 | $118 | $118 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $113 | $113 | $113 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $97 | $97 | $97 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $71 | $71 | $71 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $84 | $84 | $84 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $31 | $31 | $31 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $9 | $9 | $9 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $12 | $12 | $12 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $89 | $89 | $89 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $119 | $119 | $119 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $15 | $15 | $15 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $7 | $7 | $7 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $169 | $169 | $169 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $730 | $730 | $730 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $42 | $42 | $42 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $1,808 | $1,808 | $1,808 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $214 | $214 | $214 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $630 | $630 | $630 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $397 | $397 | $397 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $184 | $184 | $184 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $144 | $144 | $144 |
| Septoplasty CPT 30520 • ENT | $496 | $496 | $496 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $159 | $159 | $159 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $51 | $51 | $51 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $193 | $193 | $193 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $371 | $371 | $371 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $263 | $263 | $263 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $146 | $146 | $146 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $215 | $215 | $215 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $307 | $307 | $307 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $145 | $145 | $145 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $228 | $228 | $228 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $238 | $238 | $238 |