| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $175 | $175 | $175 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $211 | $211 | $211 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $100 | $112 | $136 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $50 | $109 | $169 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $60 | $60 | $60 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $72 | $72 | $72 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $80 | $127 | $174 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $212 | $212 | $212 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $50 | $143 | $236 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $149 | $149 | $149 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $50 | $161 | $273 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $326 | $326 | $326 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $50 | $186 | $354 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $185 | $185 | $185 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $78 | $91 | $105 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $95 | $95 | $95 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $8 | $8 | $8 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $214 | $214 | $214 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $50 | $102 | $155 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $50 | $101 | $129 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $64 | $64 | $64 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $66 | $66 | $66 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $6 | $14 | $21 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $2 | $3 | $6 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $9 | $43 | $60 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $47 | $48 | $50 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $60 | $326 | $592 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $15 | $84 | $153 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $7 | $36 | $65 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $78 | $335 | $593 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $704 | $3,650 | $6,596 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $25 | $131 | $236 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $262 | $1,824 | $2,604 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $220 | $220 | $220 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $572 | $635 | $699 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $325 | $352 | $366 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $181 | $192 | $203 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $50 | $323 | $632 |
| Septoplasty CPT 30520 • ENT | $50 | $480 | $910 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $50 | $123 | $196 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $50 | $173 | $295 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $50 | $213 | $375 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $50 | $232 | $415 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $50 | $330 | $609 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $170 | $213 | $300 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $483 | $483 | $483 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $770 | $770 | $770 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $202 | $212 | $222 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $50 | $244 | $439 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $455 | $455 | $455 |