| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $75 | $75 | $75 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $231 | $231 | $231 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $6 | $22 | $53 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $185 | $219 | $253 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $160 | $179 | $197 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $176 | $206 | $236 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $125 | $172 | $219 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $233 | $322 | $412 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $258 | $288 | $317 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $158 | $275 | $393 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $185 | $354 | $523 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $227 | $417 | $606 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $42 | $357 | $653 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $308 | $327 | $345 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $169 | $180 | $192 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $99 | $124 | $149 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $9 | $13 | $16 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $150 | $283 | $416 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $102 | $195 | $287 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $103 | $190 | $341 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $152 | $163 | $174 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $248 | $359 | $471 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $13 | $39 | $65 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $2 | $10 | $22 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $24 | $43 | $61 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $14 | $14 | $14 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $123 | $123 | $123 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $30 | $30 | $30 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $13 | $13 | $13 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $159 | $159 | $159 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $1,434 | $1,434 | $1,434 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $48 | $48 | $48 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $537 | $1,623 | $2,708 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $572 | $580 | $589 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $1,628 | $1,628 | $1,628 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $384 | $934 | $1,241 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $178 | $390 | $517 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $274 | $592 | $1,216 |
| Septoplasty CPT 30520 • ENT | $986 | $1,341 | $1,697 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $330 | $486 | $643 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $293 | $422 | $552 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $385 | $691 | $996 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $641 | $774 | $907 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $499 | $922 | $1,344 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $172 | $207 | $277 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $408 | $734 | $1,060 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $582 | $1,139 | $1,695 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $25 | $284 | $536 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $442 | $674 | $906 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $461 | $706 | $951 |