| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $58 | $58 | $58 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $153 | $163 | $174 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $30 | $67 | $100 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $30 | $63 | $97 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $30 | $46 | $72 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $30 | $59 | $88 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $30 | $76 | $121 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $30 | $90 | $149 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $166 | $166 | $166 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $30 | $55 | $105 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $30 | $110 | $189 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $232 | $232 | $232 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $30 | $142 | $254 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $30 | $115 | $201 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $30 | $45 | $61 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $30 | $57 | $83 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $8 | $19 | $30 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $30 | $107 | $184 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $30 | $71 | $109 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $91 | $110 | $129 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $70 | $98 | $112 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $75 | $75 | $75 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $8 | $16 | $24 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $3 | $5 | $8 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $13 | $43 | $73 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $53 | $60 | $67 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $89 | $389 | $690 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $20 | $99 | $178 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $12 | $55 | $77 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $121 | $658 | $927 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $1,087 | $4,579 | $8,071 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $34 | $192 | $270 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $2,280 | $2,623 | $3,041 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $221 | $221 | $221 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $904 | $904 | $904 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $480 | $640 | $800 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $200 | $267 | $333 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $30 | $241 | $452 |
| Septoplasty CPT 30520 • ENT | $650 | $650 | $650 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $231 | $231 | $231 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $30 | $57 | $84 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $30 | $187 | $343 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $306 | $306 | $306 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $30 | $240 | $450 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $175 | $191 | $221 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $30 | $193 | $356 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $30 | $299 | $568 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $30 | $114 | $198 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $30 | $175 | $320 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $30 | $181 | $332 |