| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $48 | $48 | $48 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $101 | $101 | $101 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $30 | $42 | $67 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $34 | $34 | $34 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $30 | $50 | $70 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $46 | $46 | $46 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $124 | $124 | $124 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $30 | $91 | $151 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $168 | $168 | $168 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $138 | $138 | $138 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $120 | $120 | $120 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $226 | $226 | $226 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $222 | $233 | $244 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $201 | $201 | $201 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $54 | $54 | $54 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $43 | $43 | $43 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $6 | $6 | $6 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $155 | $155 | $155 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $110 | $110 | $110 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $30 | $80 | $129 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $79 | $79 | $79 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $109 | $109 | $109 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $5 | $6 | $8 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $2 | $4 | $7 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $18 | $58 | $104 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $38 | $56 | $74 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $48 | $288 | $529 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $12 | $17 | $23 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $5 | $5 | $5 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $61 | $388 | $714 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $555 | $5,657 | $10,758 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $19 | $113 | $207 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $208 | $2,180 | $4,027 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $228 | $228 | $228 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $630 | $630 | $630 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $397 | $487 | $576 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $184 | $209 | $233 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $32 | $127 | $221 |
| Septoplasty CPT 30520 • ENT | $505 | $505 | $505 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $216 | $240 | $265 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $49 | $49 | $49 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $122 | $122 | $122 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $416 | $416 | $416 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $321 | $321 | $321 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $178 | $201 | $213 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $203 | $203 | $203 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $374 | $374 | $374 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $101 | $118 | $134 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $223 | $223 | $223 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $233 | $276 | $320 |