| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $61 | $339 | $708 |
| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $77 | $410 | $708 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $94 | $480 | $708 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $21 | $438 | $708 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $32 | $441 | $708 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $65 | $547 | $708 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $29 | $458 | $708 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $50 | $400 | $708 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $64 | $407 | $708 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $71 | $388 | $708 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $86 | $475 | $708 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $121 | $428 | $708 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $92 | $437 | $708 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $152 | $394 | $708 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $125 | $378 | $708 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $68 | $467 | $708 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $33 | $459 | $708 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $4 | $532 | $708 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $60 | $411 | $708 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $47 | $448 | $708 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $51 | $451 | $708 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $71 | $71 | $71 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $100 | $505 | $708 |
| 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 | $9 | $9 | $9 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $35 | $35 | $35 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $47 | $47 | $47 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $12 | $12 | $12 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $5 | $5 | $5 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $61 | $61 | $61 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $525 | $525 | $525 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $17 | $17 | $17 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $1,385 | $1,385 | $1,385 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $208 | $208 | $208 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $630 | $630 | $630 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $342 | $342 | $342 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $169 | $169 | $169 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $175 | $919 | $2,296 |
| Septoplasty CPT 30520 • ENT | $399 | $1,153 | $2,296 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $134 | $577 | $1,082 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $119 | $483 | $708 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $156 | $717 | $1,304 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $260 | $1,587 | $3,994 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $202 | $1,418 | $3,994 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $112 | $988 | $2,651 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $165 | $1,343 | $3,994 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $235 | $1,355 | $3,994 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $84 | $418 | $708 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $179 | $1,454 | $4,803 |