| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $351 | $351 | $351 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $153 | $294 | $435 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $100 | $161 | $283 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $119 | $298 | $434 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $105 | $183 | $296 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $114 | $283 | $410 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $125 | $259 | $358 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $153 | $324 | $437 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $421 | $451 | $481 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $140 | $343 | $489 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $193 | $482 | $699 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $640 | $736 | $832 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $238 | $609 | $902 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $568 | $648 | $728 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $79 | $198 | $322 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $65 | $150 | $196 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $0 | $9 | $19 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $164 | $335 | $472 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $110 | $276 | $401 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $129 | $325 | $476 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $112 | $230 | $347 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $468 | $468 | $468 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $8 | $8 | $8 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $3 | $3 | $3 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $18 | $46 | $73 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $72 | $72 | $72 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $94 | $94 | $94 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $24 | $24 | $24 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $10 | $43 | $77 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $126 | $527 | $927 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $1,099 | $1,099 | $1,099 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $37 | $154 | $270 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $2,761 | $2,901 | $3,041 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $401 | $401 | $401 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $1,047 | $1,047 | $1,047 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $800 | $834 | $869 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $333 | $348 | $362 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $291 | $925 | $1,619 |
| Septoplasty CPT 30520 • ENT | $1,980 | $2,142 | $2,303 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $502 | $570 | $637 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $184 | $499 | $766 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $250 | $650 | $954 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $1,026 | $1,153 | $1,279 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $317 | $922 | $1,506 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $175 | $292 | $525 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $259 | $742 | $1,195 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $370 | $1,124 | $1,901 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $188 | $486 | $708 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $285 | $745 | $1,096 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $297 | $776 | $1,137 |