| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $125 | $125 | $125 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $151 | $151 | $151 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $56 | $56 | $56 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $43 | $43 | $43 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $58 | $58 | $58 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $69 | $69 | $69 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $62 | $62 | $62 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $118 | $118 | $118 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $131 | $131 | $131 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $112 | $112 | $112 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $149 | $149 | $149 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $179 | $179 | $179 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $195 | $195 | $195 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $158 | $158 | $158 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $82 | $82 | $82 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $64 | $64 | $64 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $6 | $6 | $6 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $119 | $119 | $119 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $50 | $50 | $50 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $65 | $65 | $65 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $43 | $43 | $43 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $147 | $147 | $147 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $18 | $18 | $18 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $6 | $6 | $6 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $41 | $41 | $41 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $42 | $42 | $42 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $98 | $98 | $98 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $22 | $22 | $22 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $9 | $9 | $9 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $140 | $140 | $140 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $1,202 | $1,202 | $1,202 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $26 | $26 | $26 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $2,172 | $2,172 | $2,172 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $161 | $161 | $161 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $710 | $710 | $710 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $350 | $350 | $350 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $146 | $146 | $146 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $416 | $416 | $416 |
| Septoplasty CPT 30520 • ENT | $581 | $581 | $581 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $220 | $220 | $220 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $83 | $83 | $83 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $202 | $202 | $202 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $251 | $251 | $251 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $460 | $460 | $460 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $182 | $182 | $182 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $293 | $293 | $293 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $466 | $466 | $466 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $157 | $157 | $157 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $318 | $318 | $318 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $333 | $333 | $333 |