| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $157 | $157 | $157 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $30 | $58 | $103 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $30 | $84 | $123 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $30 | $30 | $30 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $30 | $37 | $44 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $30 | $80 | $129 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $30 | $48 | $66 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $73 | $73 | $73 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $30 | $66 | $101 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $30 | $115 | $199 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $143 | $143 | $143 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $246 | $246 | $246 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $204 | $204 | $204 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $30 | $30 | $30 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $30 | $46 | $57 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $6 | $22 | $30 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $30 | $97 | $163 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $30 | $79 | $114 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $112 | $126 | $134 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $111 | $111 | $112 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $146 | $146 | $146 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $4 | $4 | $4 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $2 | $2 | $3 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $11 | $32 | $52 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $39 | $39 | $39 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $690 | $690 | $690 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $13 | $70 | $127 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $40 | $49 | $57 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $60 | $418 | $695 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $5,752 | $5,752 | $5,752 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $145 | $169 | $193 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $2,154 | $2,597 | $3,041 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $175 | $175 | $175 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $326 | $563 | $799 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $15 | $83 | $151 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $30 | $178 | $326 |
| Septoplasty CPT 30520 • ENT | $746 | $746 | $746 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $30 | $134 | $208 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $30 | $213 | $329 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $482 | $482 | $482 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $30 | $189 | $348 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $194 | $194 | $194 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $30 | $30 | $30 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $30 | $200 | $369 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $188 | $205 | $222 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $30 | $180 | $330 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $30 | $30 | $30 |
| Tonsillectomy primary under age 12 CPT 42826 • ENT | $291 | $291 | $291 |
| Adenoidectomy primary under age 12 CPT 42830 • ENT | $30 | $136 | $242 |
| Removal impacted cerumen unilateral CPT 69210 • ENT | $30 | $33 | $36 |