| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $206 | $206 | $206 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $249 | $249 | $249 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $93 | $121 | $150 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $71 | $71 | $71 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $54 | $54 | $54 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $114 | $114 | $114 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $104 | $104 | $104 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $196 | $196 | $196 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $218 | $218 | $218 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $182 | $182 | $182 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $247 | $247 | $247 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $295 | $295 | $295 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $321 | $321 | $321 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $164 | $164 | $164 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $135 | $135 | $135 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $105 | $105 | $105 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $11 | $11 | $11 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $191 | $191 | $191 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $138 | $138 | $138 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $168 | $185 | $202 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $89 | $89 | $89 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $97 | $97 | $97 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $23 | $23 | $23 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $8 | $8 | $8 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $52 | $52 | $52 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $15 | $15 | $15 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $98 | $98 | $98 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $22 | $22 | $22 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $11 | $11 | $11 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $140 | $140 | $140 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $1,202 | $1,202 | $1,202 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $33 | $33 | $33 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $2,764 | $2,764 | $2,764 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $211 | $211 | $211 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $904 | $904 | $904 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $458 | $458 | $458 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $191 | $191 | $191 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $216 | $421 | $592 |
| Septoplasty CPT 30520 • ENT | $537 | $680 | $824 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $310 | $310 | $310 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $267 | $267 | $267 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $469 | $551 | $634 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $414 | $414 | $414 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $611 | $694 | $778 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $218 | $252 | $300 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $483 | $483 | $483 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $770 | $770 | $770 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $259 | $283 | $308 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $421 | $421 | $421 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $441 | $441 | $441 |