| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $195 | $195 | $195 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $153 | $195 | $237 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $30 | $89 | $149 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $30 | $107 | $184 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $30 | $92 | $153 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $30 | $53 | $76 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $30 | $110 | $190 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $30 | $130 | $230 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $257 | $257 | $257 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $30 | $120 | $210 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $30 | $165 | $299 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $354 | $354 | $354 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $30 | $145 | $260 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $312 | $312 | $312 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $30 | $93 | $156 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $30 | $73 | $117 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $15 | $23 | $30 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $30 | $131 | $233 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $30 | $70 | $109 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $129 | $165 | $202 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $97 | $105 | $112 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $218 | $218 | $218 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $25 | $25 | $25 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $3 | $6 | $9 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $65 | $69 | $73 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $80 | $80 | $80 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $106 | $106 | $106 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $24 | $24 | $24 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $14 | $45 | $77 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $143 | $535 | $927 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $1,294 | $1,294 | $1,294 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $41 | $156 | $270 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $455 | $1,748 | $3,041 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $264 | $264 | $264 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $1,033 | $1,033 | $1,033 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $572 | $686 | $800 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $238 | $286 | $333 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $30 | $364 | $699 |
| Septoplasty CPT 30520 • ENT | $998 | $998 | $998 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $218 | $218 | $218 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $30 | $67 | $105 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $30 | $220 | $411 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $444 | $444 | $444 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $30 | $340 | $651 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $175 | $248 | $321 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $30 | $273 | $516 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $30 | $426 | $822 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $30 | $126 | $222 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $30 | $252 | $474 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $30 | $261 | $492 |