| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $247 | $247 | $247 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $300 | $300 | $300 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $109 | $145 | $215 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $266 | $266 | $266 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $220 | $220 | $220 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $228 | $228 | $228 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $103 | $175 | $247 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $302 | $302 | $302 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $368 | $368 | $368 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $276 | $276 | $276 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $242 | $242 | $242 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $185 | $347 | $508 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $264 | $376 | $489 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $400 | $400 | $400 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $220 | $220 | $220 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $107 | $107 | $107 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $12 | $12 | $12 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $313 | $313 | $313 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $219 | $219 | $219 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $9 | $150 | $292 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $155 | $186 | $217 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $322 | $322 | $322 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $5 | $6 | $7 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $2 | $4 | $7 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $9 | $35 | $50 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $40 | $54 | $69 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $49 | $275 | $500 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $18 | $74 | $129 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $5 | $36 | $66 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $63 | $433 | $803 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $985 | $3,416 | $5,846 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $19 | $97 | $175 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $1,977 | $2,163 | $2,310 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $199 | $204 | $210 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $823 | $823 | $823 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $434 | $434 | $435 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $180 | $181 | $181 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $348 | $354 | $359 |
| Septoplasty CPT 30520 • ENT | $1,283 | $1,283 | $1,283 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $284 | $284 | $284 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $467 | $467 | $467 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $319 | $319 | $319 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $492 | $492 | $492 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $656 | $656 | $656 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $212 | $263 | $364 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $732 | $732 | $732 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $40 | $601 | $1,161 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $231 | $332 | $432 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $668 | $668 | $668 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $604 | $604 | $604 |