| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $76 | $76 | $76 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $230 | $230 | $230 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $54 | $73 | $92 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $82 | $82 | $82 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $62 | $62 | $62 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $73 | $73 | $73 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $190 | $190 | $190 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $233 | $233 | $233 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $259 | $259 | $259 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $212 | $212 | $212 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $187 | $187 | $187 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $230 | $230 | $230 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $223 | $300 | $376 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $309 | $309 | $309 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $86 | $86 | $86 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $99 | $99 | $99 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $9 | $9 | $9 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $151 | $151 | $151 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $103 | $103 | $103 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $119 | $159 | $199 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $172 | $172 | $172 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $246 | $246 | $246 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $5 | $5 | $5 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $2 | $2 | $2 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $41 | $51 | $61 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $37 | $37 | $37 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $62 | $62 | $62 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $15 | $15 | $15 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $7 | $7 | $7 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $82 | $82 | $82 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $730 | $730 | $730 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $26 | $26 | $26 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $1,808 | $2,329 | $2,851 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $214 | $214 | $214 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $630 | $630 | $630 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $397 | $405 | $412 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $184 | $188 | $191 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $173 | $226 | $279 |
| Septoplasty CPT 30520 • ENT | $992 | $992 | $992 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $219 | $219 | $219 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $291 | $291 | $291 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $248 | $248 | $248 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $644 | $644 | $644 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $509 | $509 | $509 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $175 | $229 | $283 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $416 | $416 | $416 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $594 | $594 | $594 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $184 | $238 | $292 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $449 | $449 | $449 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $468 | $468 | $468 |