| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $16 | $62 | $107 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $130 | $130 | $130 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $42 | $63 | $83 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $15 | $59 | $102 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $42 | $53 | $63 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $31 | $36 | $42 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $10 | $26 | $42 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $42 | $69 | $96 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $49 | $49 | $49 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $44 | $44 | $44 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $25 | $94 | $164 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $98 | $98 | $98 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $43 | $127 | $212 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $42 | $48 | $54 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $8 | $25 | $42 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $23 | $32 | $42 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $42 | $42 | $42 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $42 | $42 | $42 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $6 | $50 | $94 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $11 | $62 | $112 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $13 | $38 | $64 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $103 | $119 | $136 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $5 | $5 | $6 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $2 | $2 | $2 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $48 | $55 | $63 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $47 | $54 | $62 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $75 | $414 | $753 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $184 | $184 | $184 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $11 | $59 | $107 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $754 | $880 | $1,005 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $6,789 | $7,921 | $9,052 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $30 | $30 | $30 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $2,376 | $2,772 | $3,168 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $99 | $149 | $198 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $55 | $55 | $55 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $40 | $40 | $40 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $24 | $92 | $160 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $466 | $466 | $466 |
| Septoplasty CPT 30520 • ENT | $42 | $350 | $657 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $36 | $39 | $42 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $42 | $132 | $222 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $128 | $201 | $273 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $43 | $166 | $288 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $63 | $243 | $423 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $157 | $183 | $209 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $42 | $105 | $168 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $42 | $42 | $42 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $24 | $24 | $24 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $51 | $194 | $337 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $42 | $196 | $351 |