| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $100 | $100 | $100 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $121 | $121 | $121 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $76 | $76 | $76 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $44 | $44 | $44 |
| 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 | $89 | $89 | $89 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $64 | $64 | $64 |
| 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 | $107 | $107 | $107 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $97 | $97 | $97 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $181 | $181 | $181 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $196 | $196 | $196 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $159 | $159 | $159 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $80 | $80 | $80 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $43 | $43 | $43 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $8 | $8 | $8 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $81 | $81 | $81 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $87 | $87 | $87 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $69 | $69 | $69 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $54 | $54 | $54 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $123 | $123 | $123 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $19 | $19 | $19 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $6 | $6 | $6 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $9 | $9 | $9 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $51 | $51 | $51 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $79 | $79 | $79 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $18 | $18 | $18 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $11 | $11 | $11 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $107 | $107 | $107 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $971 | $971 | $971 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $35 | $35 | $35 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $341 | $341 | $341 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $255 | $255 | $255 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $733 | $733 | $733 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $390 | $390 | $390 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $178 | $178 | $178 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $357 | $357 | $357 |
| Septoplasty CPT 30520 • ENT | $509 | $509 | $509 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $184 | $184 | $184 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $168 | $168 | $168 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $210 | $210 | $210 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $226 | $226 | $226 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $332 | $332 | $332 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $164 | $164 | $164 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $263 | $263 | $263 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $418 | $418 | $418 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $157 | $157 | $157 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $241 | $241 | $241 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $251 | $251 | $251 |