| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $53 | $53 | $53 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $164 | $164 | $164 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $67 | $81 | $108 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $57 | $78 | $88 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $113 | $113 | $113 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $51 | $51 | $51 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $135 | $135 | $135 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $63 | $108 | $148 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $122 | $152 | $183 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $150 | $150 | $150 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $131 | $131 | $131 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $247 | $247 | $247 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $216 | $233 | $266 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $219 | $219 | $219 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $59 | $73 | $99 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $28 | $56 | $71 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $6 | $11 | $15 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $170 | $170 | $170 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $101 | $107 | $120 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $115 | $124 | $141 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $124 | $124 | $124 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $71 | $71 | $71 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $5 | $5 | $5 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $2 | $2 | $2 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $46 | $46 | $46 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $35 | $35 | $35 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $47 | $47 | $47 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $12 | $12 | $12 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $5 | $5 | $5 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $61 | $61 | $61 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $525 | $525 | $525 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $17 | $17 | $17 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $1,385 | $1,385 | $1,385 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $208 | $208 | $208 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $630 | $630 | $630 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $342 | $342 | $342 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $169 | $169 | $169 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $194 | $194 | $194 |
| Septoplasty CPT 30520 • ENT | $699 | $699 | $699 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $155 | $155 | $155 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $69 | $69 | $69 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $172 | $172 | $172 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $454 | $454 | $454 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $353 | $353 | $353 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $196 | $196 | $196 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $288 | $288 | $288 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $412 | $412 | $412 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $207 | $207 | $207 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $313 | $313 | $313 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $327 | $327 | $327 |