| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $355 | $355 | $355 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $429 | $429 | $429 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $100 | $159 | $279 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $185 | $264 | $343 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $63 | $178 | $294 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $139 | $157 | $175 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $126 | $217 | $356 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $229 | $266 | $303 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $178 | $330 | $482 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $206 | $301 | $395 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $296 | $427 | $558 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $352 | $505 | $658 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $238 | $444 | $713 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $308 | $443 | $579 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $88 | $201 | $314 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $83 | $135 | $187 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $4 | $10 | $16 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $156 | $296 | $435 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $153 | $213 | $315 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $129 | $192 | $244 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $288 | $288 | $288 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $420 | $420 | $420 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $5 | $5 | $5 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $2 | $3 | $3 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $10 | $41 | $73 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $47 | $47 | $47 |
| 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 | $8 | $8 | $8 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $82 | $82 | $82 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $731 | $731 | $731 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $24 | $24 | $24 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $271 | $1,656 | $3,041 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $211 | $211 | $211 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $825 | $825 | $825 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $457 | $628 | $800 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $190 | $262 | $333 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $291 | $589 | $802 |
| Septoplasty CPT 30520 • ENT | $960 | $1,393 | $1,827 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $210 | $306 | $402 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $319 | $446 | $572 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $397 | $432 | $467 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $429 | $572 | $716 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $628 | $791 | $953 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $175 | $294 | $530 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $498 | $640 | $781 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $921 | $1,018 | $1,115 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $188 | $355 | $548 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $455 | $650 | $844 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $474 | $675 | $877 |