| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $37 | $37 | $37 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $108 | $108 | $108 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $70 | $70 | $70 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $86 | $86 | $86 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $74 | $74 | $74 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $82 | $82 | $82 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $59 | $59 | $59 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $76 | $76 | $76 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $84 | $84 | $84 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $100 | $100 | $100 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $141 | $141 | $141 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $166 | $166 | $166 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $180 | $180 | $180 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $146 | $146 | $146 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $79 | $79 | $79 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $47 | $47 | $47 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $2 | $2 | $2 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $110 | $110 | $110 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $79 | $79 | $79 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $94 | $94 | $94 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $81 | $81 | $81 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $119 | $119 | $119 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $5 | $5 | $5 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $2 | $2 | $2 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $39 | $39 | $39 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $8 | $8 | $8 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $61 | $61 | $61 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $14 | $14 | $14 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $7 | $7 | $7 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $81 | $81 | $81 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $722 | $722 | $722 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $23 | $23 | $23 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $268 | $268 | $268 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $208 | $208 | $208 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $815 | $815 | $815 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $452 | $452 | $452 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $188 | $188 | $188 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $202 | $202 | $202 |
| Septoplasty CPT 30520 • ENT | $461 | $461 | $461 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $160 | $160 | $160 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $48 | $48 | $48 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $185 | $185 | $185 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $301 | $301 | $301 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $240 | $240 | $240 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $134 | $134 | $134 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $197 | $197 | $197 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $281 | $281 | $281 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $99 | $99 | $99 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $213 | $213 | $213 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $221 | $221 | $221 |