| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $9 | $9 | $9 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $55 | $55 | $55 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $6 | $25 | $44 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $58 | $58 | $58 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $148 | $148 | $148 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $110 | $110 | $110 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $44 | $82 | $120 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $44 | $46 | $47 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $16 | $87 | $159 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $20 | $20 | $20 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $16 | $16 | $16 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $148 | $148 | $148 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $34 | $34 | $34 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $95 | $95 | $95 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $22 | $33 | $44 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $10 | $27 | $44 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $0 | $22 | $44 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $17 | $52 | $87 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $31 | $31 | $31 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $12 | $12 | $12 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $170 | $170 | $170 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $9 | $9 | $9 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $5 | $5 | $6 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $2 | $2 | $3 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $49 | $51 | $54 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $5 | $27 | $50 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $48 | $264 | $479 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $125 | $125 | $126 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $5 | $27 | $50 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $480 | $481 | $481 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $535 | $2,982 | $5,428 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $192 | $193 | $193 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $211 | $898 | $1,585 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $32 | $32 | $32 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $68 | $68 | $68 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $64 | $190 | $317 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $26 | $26 | $26 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $19 | $19 | $19 |
| Septoplasty CPT 30520 • ENT | $384 | $384 | $384 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $192 | $192 | $192 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $44 | $44 | $44 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $73 | $73 | $73 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $313 | $313 | $313 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $431 | $431 | $431 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $44 | $95 | $145 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $44 | $44 | $44 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $44 | $273 | $503 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $141 | $141 | $141 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $235 | $235 | $235 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $44 | $55 | $66 |