| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $259 | $259 | $259 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $322 | $322 | $322 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $125 | $153 | $208 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $251 | $251 | $251 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $43 | $130 | $217 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $240 | $240 | $240 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $175 | $175 | $175 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $43 | $174 | $306 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $340 | $340 | $340 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $298 | $298 | $298 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $251 | $251 | $251 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $473 | $473 | $473 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $509 | $626 | $742 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $422 | $422 | $422 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $108 | $108 | $108 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $140 | $140 | $140 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $12 | $12 | $12 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $201 | $201 | $201 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $140 | $188 | $237 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $167 | $222 | $276 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $102 | $171 | $239 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $309 | $309 | $309 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $3 | $12 | $21 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $1 | $4 | $6 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $42 | $64 | $86 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $21 | $32 | $43 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $28 | $298 | $568 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $8 | $90 | $172 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $5 | $12 | $19 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $397 | $675 | $953 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $283 | $3,063 | $5,843 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $20 | $63 | $106 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $827 | $1,375 | $1,922 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $217 | $244 | $270 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $349 | $349 | $349 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $349 | $349 | $349 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $144 | $168 | $180 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $362 | $579 | $797 |
| Septoplasty CPT 30520 • ENT | $1,401 | $1,401 | $1,401 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $456 | $456 | $456 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $389 | $389 | $389 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $531 | $531 | $531 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $901 | $901 | $901 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $652 | $652 | $652 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $364 | $364 | $364 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $537 | $537 | $537 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $763 | $763 | $763 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $282 | $283 | $284 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $603 | $603 | $603 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $630 | $630 | $630 |