| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $119 | $119 | $119 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $362 | $362 | $362 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $100 | $145 | $237 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $30 | $160 | $289 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $97 | $97 | $97 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $275 | $275 | $275 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $299 | $299 | $299 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $250 | $250 | $250 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $276 | $276 | $276 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $333 | $333 | $333 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $30 | $250 | $470 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $548 | $548 | $548 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $30 | $220 | $393 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $484 | $484 | $484 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $265 | $265 | $265 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $156 | $156 | $156 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $6 | $10 | $14 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $377 | $377 | $377 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $109 | $187 | $265 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $30 | $157 | $312 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $112 | $189 | $266 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $159 | $159 | $159 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $5 | $6 | $8 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $2 | $3 | $3 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $9 | $52 | $73 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $38 | $45 | $53 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $49 | $370 | $690 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $12 | $95 | $178 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $5 | $41 | $76 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $63 | $77 | $92 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $573 | $4,322 | $8,071 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $19 | $23 | $27 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $304 | $1,594 | $3,041 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $210 | $210 | $210 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $823 | $823 | $823 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $456 | $628 | $800 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $190 | $262 | $333 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $30 | $252 | $434 |
| Septoplasty CPT 30520 • ENT | $30 | $791 | $1,552 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $30 | $273 | $515 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $30 | $244 | $458 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $30 | $208 | $386 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $30 | $312 | $594 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $30 | $411 | $793 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $175 | $264 | $440 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $648 | $648 | $648 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $925 | $925 | $925 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $188 | $323 | $458 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $30 | $365 | $700 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $730 | $730 | $730 |