| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $30 | $30 | $30 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $37 | $37 | $37 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $61 | $61 | $61 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $75 | $75 | $75 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $24 | $24 | $24 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $71 | $71 | $71 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $77 | $77 | $77 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $64 | $64 | $64 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $105 | $105 | $105 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $86 | $86 | $86 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $75 | $75 | $75 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $141 | $141 | $141 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $152 | $152 | $152 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $125 | $125 | $125 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $68 | $68 | $68 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $40 | $40 | $40 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $1 | $1 | $1 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $97 | $97 | $97 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $69 | $69 | $69 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $81 | $81 | $81 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $71 | $71 | $71 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $41 | $41 | $41 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $5 | $7 | $8 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $2 | $3 | $3 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $46 | $50 | $55 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $5 | $29 | $53 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $47 | $283 | $518 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $12 | $95 | $179 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $5 | $41 | $77 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $61 | $77 | $93 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $525 | $4,298 | $8,072 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $17 | $144 | $270 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $304 | $845 | $1,385 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $208 | $288 | $369 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $630 | $823 | $1,015 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $342 | $571 | $800 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $169 | $251 | $333 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $175 | $175 | $175 |
| Septoplasty CPT 30520 • ENT | $399 | $399 | $399 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $134 | $134 | $134 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $119 | $119 | $119 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $98 | $98 | $98 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $260 | $260 | $260 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $202 | $202 | $202 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $112 | $112 | $112 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $165 | $165 | $165 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $235 | $235 | $235 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $118 | $118 | $118 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $179 | $179 | $179 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $187 | $187 | $187 |