| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $129 | $129 | $129 |
| 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 | $93 | $97 | $103 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $125 | $125 | $125 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $34 | $71 | $108 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $119 | $119 | $119 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $85 | $85 | $85 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $108 | $108 | $108 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $175 | $175 | $175 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $144 | $144 | $144 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $203 | $203 | $203 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $236 | $236 | $236 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $222 | $239 | $255 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $130 | $130 | $130 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $114 | $114 | $114 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $56 | $56 | $56 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $2 | $4 | $6 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $163 | $163 | $163 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $115 | $115 | $115 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $121 | $128 | $135 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $118 | $120 | $122 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $168 | $168 | $168 |
| 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 | $54 | $88 | $104 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $38 | $56 | $74 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $48 | $70 | $92 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $12 | $17 | $23 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $5 | $53 | $100 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $61 | $655 | $1,248 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $555 | $5,657 | $10,758 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $18 | $187 | $356 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $1,385 | $3,147 | $4,027 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $228 | $258 | $288 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $630 | $630 | $630 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $456 | $516 | $576 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $184 | $216 | $233 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $32 | $162 | $293 |
| Septoplasty CPT 30520 • ENT | $668 | $668 | $668 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $148 | $148 | $148 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $198 | $198 | $198 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $261 | $261 | $261 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $434 | $434 | $434 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $338 | $338 | $338 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $188 | $205 | $213 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $276 | $276 | $276 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $394 | $394 | $394 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $101 | $149 | $197 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $300 | $300 | $300 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $313 | $313 | $313 |