| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $25 | $25 | $25 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $27 | $27 | $27 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $41 | $77 | $100 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $30 | $83 | $119 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $37 | $58 | $79 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $9 | $9 | $9 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $87 | $106 | $124 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $66 | $90 | $114 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $73 | $79 | $84 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $10 | $20 | $30 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $30 | $83 | $135 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $222 | $222 | $223 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $30 | $33 | $36 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $122 | $122 | $122 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $39 | $59 | $78 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $30 | $42 | $57 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $6 | $6 | $7 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $19 | $19 | $19 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $16 | $73 | $109 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $30 | $73 | $112 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $56 | $84 | $112 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $15 | $15 | $15 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $8 | $8 | $8 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $3 | $3 | $3 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $54 | $54 | $55 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $8 | $30 | $53 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $414 | $552 | $691 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $13 | $123 | $179 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $76 | $76 | $77 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $60 | $236 | $555 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $807 | $4,439 | $8,071 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $202 | $236 | $270 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $3,041 | $3,041 | $3,041 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $55 | $55 | $55 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $102 | $102 | $102 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $160 | $160 | $160 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $333 | $333 | $333 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $17 | $24 | $30 |
| Septoplasty CPT 30520 • ENT | $30 | $248 | $466 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $30 | $30 | $30 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $30 | $64 | $133 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $30 | $136 | $329 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $30 | $30 | $30 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $30 | $134 | $238 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $18 | $106 | $195 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $30 | $41 | $52 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $74 | $74 | $74 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $188 | $188 | $188 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $30 | $30 | $30 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $59 | $59 | $59 |