| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $27 | $27 | $27 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $83 | $83 | $83 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $40 | $80 | $100 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $28 | $28 | $28 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $39 | $39 | $39 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $49 | $49 | $49 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $69 | $97 | $124 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $58 | $105 | $152 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $93 | $93 | $93 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $76 | $76 | $76 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $66 | $66 | $66 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $129 | $129 | $129 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $140 | $189 | $238 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $113 | $113 | $113 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $54 | $54 | $54 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $46 | $46 | $46 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $2 | $3 | $4 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $30 | $52 | $74 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $64 | $86 | $109 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $48 | $88 | $129 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $58 | $58 | $58 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $50 | $50 | $50 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $8 | $16 | $24 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $3 | $4 | $6 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $13 | $40 | $73 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $50 | $51 | $53 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $69 | $74 | $78 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $18 | $98 | $178 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $10 | $43 | $76 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $92 | $99 | $106 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $953 | $4,512 | $8,071 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $34 | $152 | $270 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $304 | $1,860 | $3,041 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $211 | $211 | $211 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $593 | $593 | $593 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $421 | $610 | $800 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $170 | $252 | $333 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $291 | $327 | $363 |
| Septoplasty CPT 30520 • ENT | $505 | $505 | $505 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $192 | $192 | $192 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $161 | $161 | $161 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $145 | $145 | $145 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $218 | $218 | $218 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $319 | $319 | $319 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $158 | $170 | $175 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $253 | $253 | $253 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $402 | $402 | $402 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $140 | $164 | $188 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $210 | $210 | $210 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $218 | $218 | $218 |