| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $83 | $83 | $83 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $247 | $247 | $247 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $95 | $115 | $155 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $39 | $115 | $191 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $118 | $118 | $118 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $41 | $57 | $73 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $76 | $137 | $198 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $96 | $167 | $238 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $279 | $279 | $279 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $39 | $107 | $174 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $39 | $173 | $308 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $242 | $242 | $242 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $39 | $229 | $421 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $114 | $217 | $321 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $88 | $123 | $158 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $50 | $94 | $138 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $9 | $9 | $9 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $39 | $132 | $226 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $39 | $114 | $189 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $39 | $100 | $139 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $123 | $123 | $123 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $107 | $107 | $107 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $8 | $16 | $24 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $3 | $5 | $7 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $16 | $51 | $87 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $12 | $50 | $88 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $78 | $94 | $109 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $15 | $142 | $269 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $10 | $54 | $98 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $106 | $808 | $1,511 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $953 | $6,895 | $12,837 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $25 | $241 | $457 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $476 | $2,494 | $4,770 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $264 | $264 | $264 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $529 | $664 | $800 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $293 | $340 | $434 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $163 | $186 | $208 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $39 | $365 | $763 |
| Septoplasty CPT 30520 • ENT | $39 | $524 | $1,010 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $237 | $237 | $237 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $39 | $189 | $339 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $39 | $302 | $566 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $39 | $256 | $473 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $39 | $366 | $693 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $174 | $230 | $343 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $550 | $550 | $550 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $365 | $620 | $875 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $142 | $227 | $333 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $39 | $259 | $478 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $496 | $496 | $496 |