| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $69 | $69 | $69 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $84 | $84 | $84 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $75 | $92 | $100 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $40 | $70 | $101 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $78 | $78 | $78 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $40 | $66 | $93 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $133 | $133 | $133 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $159 | $159 | $159 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $121 | $121 | $121 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $110 | $110 | $110 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $40 | $120 | $201 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $239 | $239 | $239 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $40 | $150 | $241 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $211 | $211 | $211 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $110 | $110 | $110 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $59 | $59 | $59 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $9 | $9 | $9 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $153 | $153 | $153 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $40 | $54 | $69 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $40 | $102 | $136 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $74 | $74 | $74 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $196 | $196 | $196 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $5 | $19 | $33 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $2 | $5 | $10 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $14 | $32 | $66 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $18 | $35 | $51 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $140 | $392 | $644 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $32 | $99 | $167 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $16 | $43 | $70 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $199 | $529 | $859 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $1,459 | $4,314 | $7,170 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $46 | $152 | $257 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $2,123 | $2,967 | $3,949 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $299 | $299 | $299 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $989 | $989 | $989 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $311 | $371 | $490 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $173 | $208 | $242 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $40 | $282 | $483 |
| Septoplasty CPT 30520 • ENT | $40 | $352 | $665 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $254 | $254 | $254 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $40 | $129 | $218 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $40 | $211 | $382 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $40 | $186 | $333 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $40 | $266 | $492 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $198 | $212 | $241 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $389 | $389 | $389 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $417 | $518 | $620 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $153 | $181 | $210 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $40 | $189 | $338 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $40 | $198 | $355 |