| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $49 | $49 | $49 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $60 | $60 | $60 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $35 | $68 | $84 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $53 | $53 | $53 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $95 | $95 | $95 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $108 | $108 | $108 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $78 | $92 | $106 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $142 | $142 | $142 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $158 | $158 | $158 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $129 | $129 | $129 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $184 | $184 | $184 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $219 | $219 | $219 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $204 | $221 | $237 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $192 | $192 | $192 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $51 | $82 | $113 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $45 | $48 | $52 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $2 | $4 | $5 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $98 | $98 | $98 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $68 | $68 | $68 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $83 | $97 | $111 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $67 | $67 | $67 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $149 | $149 | $149 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $8 | $13 | $19 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $3 | $4 | $7 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $37 | $57 | $67 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $8 | $30 | $53 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $60 | $255 | $450 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $15 | $96 | $178 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $6 | $7 | $7 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $78 | $386 | $695 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $704 | $4,388 | $8,071 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $23 | $135 | $247 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $304 | $1,572 | $2,662 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $200 | $200 | $200 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $783 | $783 | $783 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $411 | $422 | $434 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $181 | $184 | $187 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $293 | $360 | $426 |
| Septoplasty CPT 30520 • ENT | $606 | $606 | $606 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $220 | $220 | $220 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $202 | $202 | $202 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $251 | $251 | $251 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $270 | $270 | $270 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $396 | $396 | $396 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $177 | $183 | $196 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $314 | $314 | $314 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $500 | $500 | $500 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $134 | $162 | $190 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $288 | $288 | $288 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $299 | $299 | $299 |