| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $190 | $190 | $190 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $230 | $230 | $230 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $44 | $80 | $151 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $83 | $83 | $83 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $152 | $152 | $152 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $74 | $74 | $74 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $44 | $85 | $125 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $122 | $141 | $161 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $44 | $111 | $178 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $160 | $160 | $160 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $298 | $298 | $298 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $353 | $353 | $353 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $108 | $181 | $254 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $309 | $309 | $309 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $38 | $100 | $163 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $41 | $71 | $102 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $4 | $4 | $5 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $154 | $154 | $154 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $172 | $172 | $172 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $44 | $124 | $203 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $173 | $173 | $173 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $252 | $252 | $252 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $5 | $5 | $6 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $2 | $2 | $3 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $9 | $35 | $49 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $7 | $22 | $38 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $60 | $317 | $573 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $23 | $73 | $124 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $7 | $30 | $52 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $73 | $357 | $641 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $710 | $3,032 | $5,353 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $23 | $164 | $305 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $1,760 | $1,996 | $2,114 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $202 | $202 | $202 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $497 | $554 | $611 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $48 | $189 | $331 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $163 | $170 | $177 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $44 | $233 | $422 |
| Septoplasty CPT 30520 • ENT | $941 | $941 | $941 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $346 | $346 | $346 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $322 | $322 | $322 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $246 | $246 | $246 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $623 | $623 | $623 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $502 | $502 | $502 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $44 | $122 | $279 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $411 | $411 | $411 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $586 | $586 | $586 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $44 | $176 | $291 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $446 | $446 | $446 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $462 | $462 | $462 |