| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $157 | $157 | $157 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $189 | $189 | $189 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $114 | $115 | $115 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $45 | $226 | $407 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $31 | $79 | $127 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $40 | $214 | $389 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $280 | $280 | $280 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $521 | $521 | $521 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $386 | $386 | $386 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $478 | $478 | $478 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $45 | $352 | $659 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $180 | $471 | $762 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $45 | $381 | $817 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $158 | $290 | $421 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $86 | $235 | $384 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $46 | $135 | $224 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $22 | $34 | $45 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $331 | $331 | $331 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $45 | $134 | $223 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $45 | $213 | $441 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $386 | $386 | $386 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $520 | $520 | $520 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $8 | $16 | $23 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $2 | $4 | $6 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $58 | $64 | $75 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $10 | $31 | $51 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $94 | $212 | $329 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $24 | $84 | $143 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $4 | $7 | $10 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $86 | $106 | $126 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $1,099 | $4,433 | $7,767 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $37 | $140 | $243 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $1,969 | $2,233 | $2,761 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $401 | $401 | $401 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $757 | $902 | $1,047 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $608 | $739 | $869 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $277 | $320 | $362 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $45 | $510 | $1,120 |
| Septoplasty CPT 30520 • ENT | $45 | $1,303 | $2,560 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $575 | $575 | $575 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $45 | $376 | $708 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $45 | $323 | $602 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $45 | $481 | $916 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $45 | $632 | $1,219 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $227 | $378 | $679 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $45 | $522 | $1,000 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $484 | $953 | $1,423 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $258 | $382 | $506 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $45 | $567 | $1,089 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $45 | $592 | $1,140 |