| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $157 | $157 | $157 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $518 | $518 | $518 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $41 | $85 | $114 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $100 | $253 | $407 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $96 | $225 | $353 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $153 | $153 | $153 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $73 | $176 | $280 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $66 | $242 | $521 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $73 | $323 | $573 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $353 | $353 | $353 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $407 | $407 | $407 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $42 | $402 | $762 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $219 | $378 | $538 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $111 | $266 | $421 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $43 | $214 | $384 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $48 | $110 | $224 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $6 | $11 | $22 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $151 | $241 | $331 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $42 | $167 | $377 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $7 | $131 | $274 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $91 | $238 | $386 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $214 | $214 | $214 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $6 | $7 | $8 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $2 | $3 | $3 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $52 | $68 | $100 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $40 | $61 | $72 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $94 | $235 | $515 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $13 | $57 | $133 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $10 | $27 | $56 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $60 | $291 | $687 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $1,099 | $2,769 | $5,736 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $20 | $31 | $37 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $414 | $1,459 | $2,265 |
| 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 | $305 | $493 | $869 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $170 | $266 | $362 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $343 | $508 | $673 |
| Septoplasty CPT 30520 • ENT | $2,560 | $2,560 | $2,560 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $824 | $824 | $824 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $133 | $420 | $708 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $329 | $648 | $966 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $1,653 | $1,653 | $1,653 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $1,219 | $1,219 | $1,219 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $203 | $361 | $679 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $1,000 | $1,000 | $1,000 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $1,423 | $1,423 | $1,423 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $200 | $302 | $506 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $1,089 | $1,089 | $1,089 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $311 | $725 | $1,140 |