| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $167 | $167 | $167 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $30 | $64 | $97 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $30 | $30 | $30 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $30 | $34 | $37 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $30 | $38 | $45 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $30 | $55 | $80 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $30 | $30 | $30 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $30 | $30 | $30 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $30 | $30 | $30 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $30 | $30 | $30 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $30 | $133 | $235 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $218 | $218 | $218 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $30 | $63 | $96 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $30 | $30 | $30 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $30 | $30 | $30 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $30 | $30 | $30 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $30 | $70 | $109 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $30 | $79 | $127 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $112 | $114 | $116 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $157 | $157 | $157 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $8 | $8 | $8 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $2 | $3 | $3 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $44 | $59 | $73 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $12 | $33 | $53 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $96 | $307 | $518 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $31 | $104 | $178 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $7 | $28 | $60 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $92 | $332 | $732 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $6,373 | $6,373 | $6,373 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $37 | $154 | $223 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $1,791 | $2,416 | $3,041 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $208 | $208 | $208 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $452 | $452 | $452 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $188 | $200 | $212 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $30 | $30 | $30 |
| Septoplasty CPT 30520 • ENT | $30 | $30 | $30 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $30 | $30 | $30 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $30 | $30 | $30 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $30 | $30 | $30 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $30 | $30 | $30 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $184 | $184 | $184 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $30 | $179 | $327 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $30 | $238 | $445 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $217 | $217 | $217 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $30 | $30 | $30 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $30 | $187 | $344 |
| Tonsillectomy primary under age 12 CPT 42826 • ENT | $30 | $30 | $30 |
| Adenoidectomy primary under age 12 CPT 42830 • ENT | $30 | $118 | $206 |
| Tympanostomy tube insertion CPT 69436 • ENT | $155 | $163 | $172 |
| Tympanoplasty without mastoidectomy CPT 69631 • ENT | $30 | $30 | $30 |