| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $231 | $231 | $231 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $279 | $279 | $279 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $67 | $67 | $67 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $217 | $217 | $217 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $75 | $75 | $75 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $206 | $206 | $206 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $149 | $149 | $149 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $272 | $272 | $272 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $303 | $303 | $303 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $248 | $248 | $248 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $353 | $353 | $353 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $279 | $279 | $279 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $307 | $307 | $307 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $367 | $367 | $367 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $184 | $184 | $184 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $138 | $138 | $138 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $5 | $5 | $5 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $187 | $187 | $187 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $200 | $200 | $200 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $238 | $238 | $238 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $106 | $112 | $117 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $107 | $184 | $260 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $31 | $60 | $88 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $11 | $21 | $30 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $36 | $59 | $82 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $100 | $191 | $281 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $132 | $252 | $372 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $30 | $55 | $81 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $18 | $30 | $43 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $178 | $355 | $531 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $1,618 | $3,083 | $4,549 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $51 | $87 | $123 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $961 | $2,377 | $3,793 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $329 | $537 | $745 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $1,291 | $1,291 | $1,291 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $715 | $1,166 | $1,617 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $298 | $486 | $674 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $824 | $824 | $824 |
| Septoplasty CPT 30520 • ENT | $1,177 | $1,177 | $1,177 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $424 | $424 | $424 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $387 | $387 | $387 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $310 | $310 | $310 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $523 | $523 | $523 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $767 | $767 | $767 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $379 | $379 | $379 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $608 | $608 | $608 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $969 | $969 | $969 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $262 | $262 | $262 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $558 | $558 | $558 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $580 | $580 | $580 |