| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $40 | $40 | $40 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $62 | $62 | $62 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $79 | $79 | $80 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $133 | $133 | $133 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $41 | $41 | $41 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $36 | $36 | $36 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $100 | $100 | $100 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $118 | $118 | $118 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $89 | $89 | $89 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $80 | $80 | $80 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $129 | $129 | $129 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $158 | $158 | $158 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $132 | $162 | $192 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $222 | $222 | $222 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $57 | $57 | $57 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $52 | $52 | $52 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $7 | $7 | $7 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $126 | $126 | $126 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $88 | $88 | $88 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $103 | $123 | $144 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $90 | $90 | $90 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $130 | $130 | $130 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $4 | $4 | $4 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $2 | $2 | $2 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $36 | $49 | $61 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $22 | $22 | $22 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $39 | $39 | $39 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $8 | $8 | $8 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $4 | $4 | $4 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $63 | $63 | $63 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $573 | $573 | $573 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $19 | $19 | $19 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $216 | $1,462 | $2,708 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $174 | $174 | $174 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $823 | $823 | $823 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $297 | $354 | $411 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $141 | $156 | $171 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $227 | $249 | $271 |
| Septoplasty CPT 30520 • ENT | $499 | $499 | $499 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $158 | $158 | $158 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $153 | $153 | $153 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $123 | $123 | $123 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $456 | $456 | $456 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $265 | $265 | $265 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $147 | $156 | $165 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $206 | $206 | $206 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $395 | $395 | $395 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $148 | $161 | $174 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $306 | $306 | $306 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $244 | $244 | $244 |