| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $418 | $418 | $418 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $153 | $335 | $518 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $30 | $136 | $337 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $30 | $179 | $407 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $30 | $192 | $353 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $30 | $209 | $389 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $30 | $155 | $280 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $30 | $150 | $354 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $73 | $323 | $573 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $30 | $254 | $478 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $30 | $344 | $659 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $762 | $762 | $762 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $315 | $566 | $817 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $677 | $677 | $677 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $30 | $207 | $384 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $30 | $104 | $224 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $6 | $14 | $30 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $30 | $296 | $562 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $30 | $116 | $223 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $112 | $184 | $274 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $112 | $249 | $386 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $520 | $520 | $520 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $8 | $8 | $8 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $3 | $5 | $7 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $86 | $93 | $100 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $72 | $72 | $72 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $94 | $94 | $94 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $13 | $19 | $24 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $10 | $43 | $77 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $60 | $371 | $927 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $1,099 | $1,099 | $1,099 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $37 | $154 | $270 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $2,563 | $2,662 | $2,761 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $401 | $401 | $401 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $1,047 | $1,047 | $1,047 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $800 | $834 | $869 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $180 | $271 | $362 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $30 | $575 | $1,120 |
| Septoplasty CPT 30520 • ENT | $2,560 | $2,560 | $2,560 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $575 | $575 | $575 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $30 | $136 | $244 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $30 | $442 | $966 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $916 | $916 | $916 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $30 | $624 | $1,219 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $355 | $517 | $679 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $30 | $515 | $1,000 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $30 | $727 | $1,423 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $284 | $395 | $506 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $30 | $559 | $1,089 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $30 | $585 | $1,140 |