| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $59 | $59 | $59 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $136 | $136 | $136 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $65 | $88 | $100 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $87 | $87 | $87 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $67 | $67 | $67 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $62 | $62 | $62 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $30 | $60 | $89 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $107 | $107 | $107 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $119 | $119 | $119 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $95 | $95 | $95 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $106 | $106 | $106 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $136 | $136 | $136 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $116 | $177 | $238 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $89 | $89 | $89 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $94 | $94 | $94 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $51 | $58 | $65 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $2 | $5 | $7 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $104 | $104 | $104 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $59 | $84 | $109 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $60 | $94 | $129 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $62 | $62 | $62 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $169 | $169 | $169 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $8 | $16 | $23 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $3 | $5 | $8 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $52 | $60 | $73 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $53 | $53 | $54 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $69 | $84 | $98 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $22 | $100 | $178 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $11 | $44 | $76 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $140 | $533 | $927 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $1,202 | $4,636 | $8,071 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $33 | $117 | $202 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $2,764 | $2,949 | $3,041 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $211 | $211 | $211 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $904 | $904 | $904 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $458 | $629 | $800 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $191 | $262 | $333 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $291 | $307 | $323 |
| Septoplasty CPT 30520 • ENT | $450 | $450 | $450 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $127 | $127 | $127 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $186 | $186 | $186 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $189 | $189 | $189 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $226 | $226 | $226 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $333 | $333 | $333 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $164 | $171 | $175 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $337 | $337 | $337 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $369 | $453 | $536 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $134 | $161 | $188 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $293 | $293 | $293 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $308 | $308 | $308 |