| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $73 | $73 | $73 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $28 | $90 | $153 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $16 | $23 | $30 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $24 | $27 | $30 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $30 | $45 | $61 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $21 | $26 | $30 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $30 | $38 | $46 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $30 | $43 | $57 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $103 | $103 | $103 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $30 | $44 | $59 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $30 | $75 | $120 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $137 | $137 | $137 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $30 | $56 | $81 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $122 | $122 | $122 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $30 | $48 | $67 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $30 | $35 | $40 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $4 | $17 | $30 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $30 | $64 | $98 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $30 | $49 | $67 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $78 | $103 | $129 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $98 | $105 | $112 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $116 | $116 | $116 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $5 | $5 | $5 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $2 | $3 | $3 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $66 | $70 | $73 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $48 | $48 | $48 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $376 | $376 | $376 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $147 | $147 | $147 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $42 | $59 | $77 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $106 | $517 | $927 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $903 | $903 | $903 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $173 | $222 | $270 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $2,238 | $2,639 | $3,041 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $280 | $280 | $280 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $663 | $663 | $663 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $559 | $679 | $800 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $226 | $280 | $333 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $30 | $82 | $133 |
| Septoplasty CPT 30520 • ENT | $537 | $537 | $537 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $192 | $192 | $192 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $30 | $100 | $170 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $30 | $132 | $233 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $382 | $382 | $382 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $30 | $134 | $237 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $132 | $154 | $175 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $30 | $112 | $195 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $30 | $153 | $276 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $30 | $99 | $168 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $30 | $124 | $218 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $30 | $129 | $227 |