| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $78 | $78 | $78 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $78 | $123 | $167 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $30 | $38 | $46 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $30 | $57 | $85 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $30 | $92 | $153 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $30 | $53 | $75 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $30 | $78 | $126 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $30 | $96 | $162 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $211 | $211 | $211 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $30 | $120 | $210 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $30 | $92 | $154 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $354 | $354 | $354 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $264 | $289 | $315 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $311 | $311 | $311 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $30 | $51 | $72 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $30 | $66 | $102 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $4 | $17 | $30 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $30 | $106 | $183 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $30 | $69 | $109 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $129 | $166 | $204 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $116 | $128 | $141 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $208 | $208 | $208 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $5 | $5 | $5 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $2 | $2 | $3 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $38 | $49 | $60 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $34 | $34 | $34 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $61 | $61 | $61 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $23 | $23 | $23 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $7 | $34 | $60 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $73 | $403 | $732 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $710 | $710 | $710 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $23 | $123 | $223 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $1,760 | $2,081 | $2,402 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $203 | $203 | $203 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $797 | $797 | $797 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $441 | $447 | $452 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $184 | $186 | $188 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $30 | $227 | $425 |
| Septoplasty CPT 30520 • ENT | $949 | $949 | $949 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $346 | $346 | $346 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $30 | $176 | $322 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $30 | $117 | $205 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $314 | $314 | $314 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $30 | $270 | $510 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $175 | $229 | $283 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $30 | $186 | $342 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $30 | $313 | $596 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $30 | $121 | $211 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $30 | $200 | $369 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $30 | $249 | $468 |