| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $239 | $239 | $239 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $488 | $488 | $488 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $109 | $214 | $319 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $391 | $391 | $391 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $78 | $78 | $78 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $220 | $220 | $220 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $226 | $233 | $239 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $277 | $284 | $292 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $324 | $324 | $324 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $198 | $198 | $198 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $234 | $234 | $234 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $287 | $287 | $287 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $264 | $368 | $471 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $386 | $386 | $386 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $204 | $208 | $211 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $119 | $167 | $216 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $11 | $11 | $11 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $486 | $486 | $486 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $201 | $280 | $360 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $142 | $285 | $427 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $106 | $106 | $106 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $179 | $179 | $179 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $7 | $7 | $7 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $3 | $3 | $3 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $9 | $41 | $73 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $5 | $5 | $5 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $52 | $52 | $52 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $12 | $12 | $12 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $5 | $5 | $5 |
| 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 | $20 | $20 | $20 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $216 | $1,309 | $2,402 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $210 | $210 | $210 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $878 | $878 | $878 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $452 | $511 | $570 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $188 | $212 | $235 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $356 | $449 | $543 |
| Septoplasty CPT 30520 • ENT | $1,240 | $1,240 | $1,240 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $274 | $274 | $274 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $124 | $124 | $124 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $308 | $308 | $308 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $805 | $805 | $805 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $1,287 | $1,287 | $1,287 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $217 | $427 | $637 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $1,021 | $1,021 | $1,021 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $739 | $739 | $739 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $34 | $146 | $365 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $940 | $940 | $940 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $583 | $583 | $583 |