| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $21 | $21 | $21 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $227 | $227 | $227 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $83 | $117 | $150 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $23 | $23 | $23 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $58 | $58 | $58 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $69 | $69 | $69 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $44 | $44 | $44 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $89 | $89 | $89 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $255 | $255 | $255 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $82 | $82 | $82 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $296 | $296 | $296 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $73 | $73 | $73 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $77 | $145 | $213 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $116 | $116 | $116 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $64 | $64 | $64 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $97 | $97 | $97 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $3 | $3 | $3 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $47 | $47 | $47 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $168 | $168 | $168 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $112 | $154 | $196 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $67 | $67 | $67 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $179 | $179 | $179 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $3 | $3 | $3 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $1 | $2 | $2 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $23 | $43 | $64 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $22 | $22 | $22 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $489 | $489 | $489 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $107 | $107 | $107 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $41 | $41 | $41 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $636 | $636 | $636 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $903 | $903 | $903 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $31 | $31 | $31 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $778 | $1,973 | $3,169 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $280 | $280 | $280 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $354 | $354 | $354 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $397 | $478 | $559 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $104 | $132 | $161 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $87 | $277 | $466 |
| Septoplasty CPT 30520 • ENT | $516 | $516 | $516 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $126 | $126 | $126 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $154 | $154 | $154 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $153 | $153 | $153 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $117 | $117 | $117 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $155 | $155 | $155 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $143 | $176 | $209 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $127 | $127 | $127 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $300 | $300 | $300 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $115 | $168 | $221 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $230 | $230 | $230 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $240 | $240 | $240 |