| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $175 | $175 | $175 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $211 | $211 | $211 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $18 | $29 | $40 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $68 | $74 | $81 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $18 | $33 | $47 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $18 | $63 | $107 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $18 | $58 | $99 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $93 | $112 | $131 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $148 | $175 | $203 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $126 | $145 | $164 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $168 | $199 | $231 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $133 | $208 | $282 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $210 | $260 | $310 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $18 | $131 | $245 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $42 | $69 | $123 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $67 | $69 | $72 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $9 | $14 | $18 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $165 | $194 | $224 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $18 | $66 | $138 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $109 | $152 | $180 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $85 | $85 | $85 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $91 | $91 | $91 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $21 | $21 | $21 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $7 | $7 | $7 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $9 | $9 | $9 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $58 | $58 | $58 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $76 | $76 | $76 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $17 | $17 | $17 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $10 | $10 | $10 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $104 | $104 | $104 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $932 | $932 | $932 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $29 | $29 | $29 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $2,185 | $2,185 | $2,185 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $190 | $190 | $190 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $774 | $774 | $774 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $412 | $412 | $412 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $172 | $172 | $172 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $394 | $472 | $551 |
| Septoplasty CPT 30520 • ENT | $548 | $670 | $791 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $122 | $201 | $281 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $102 | $140 | $177 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $323 | $370 | $418 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $298 | $335 | $373 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $443 | $495 | $548 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $216 | $242 | $269 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $348 | $391 | $434 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $558 | $625 | $692 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $133 | $187 | $241 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $294 | $342 | $389 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $309 | $357 | $405 |