| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $79 | $79 | $79 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $98 | $125 | $153 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $6 | $19 | $30 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $30 | $53 | $77 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $30 | $44 | $66 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $30 | $51 | $73 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $30 | $114 | $232 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $30 | $64 | $99 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $109 | $109 | $109 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $30 | $60 | $91 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $30 | $54 | $77 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $93 | $93 | $93 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $42 | $98 | $155 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $80 | $80 | $80 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $30 | $51 | $73 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $30 | $32 | $35 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $1 | $16 | $30 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $30 | $68 | $106 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $30 | $37 | $43 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $84 | $93 | $103 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $75 | $105 | $127 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $98 | $98 | $98 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $3 | $5 | $7 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $1 | $2 | $3 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $13 | $41 | $74 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $16 | $37 | $59 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $75 | $177 | $280 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $8 | $428 | $847 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $18 | $60 | $85 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $364 | $739 | $927 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $283 | $4,388 | $8,494 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $97 | $212 | $270 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $827 | $2,539 | $3,749 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $163 | $215 | $266 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $154 | $154 | $154 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $268 | $534 | $800 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $132 | $176 | $218 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $30 | $108 | $187 |
| Septoplasty CPT 30520 • ENT | $428 | $428 | $428 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $96 | $129 | $162 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $30 | $35 | $40 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $30 | $96 | $162 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $152 | $152 | $152 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $30 | $116 | $202 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $113 | $152 | $172 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $30 | $78 | $166 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $30 | $99 | $236 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $25 | $94 | $172 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $30 | $108 | $186 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $30 | $112 | $194 |