| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $75 | $206 | $430 |
| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $75 | $256 | $581 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $131 | $345 | $581 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $30 | $170 | $581 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $30 | $266 | $581 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $30 | $317 | $581 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $30 | $273 | $581 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $30 | $285 | $581 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $30 | $191 | $430 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $73 | $269 | $430 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $30 | $313 | $581 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $30 | $325 | $581 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $172 | $366 | $581 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $30 | $252 | $581 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $160 | $356 | $581 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $30 | $212 | $430 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $30 | $204 | $430 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $6 | $194 | $430 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $30 | $230 | $581 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $30 | $188 | $430 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $75 | $237 | $581 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $112 | $249 | $386 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $99 | $445 | $581 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $8 | $8 | $8 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $3 | $3 | $3 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $73 | $86 | $100 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $10 | $10 | $10 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $94 | $94 | $94 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $24 | $24 | $24 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $10 | $40 | $77 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $126 | $527 | $927 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $1,099 | $1,099 | $1,099 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $37 | $154 | $270 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $2,761 | $2,901 | $3,041 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $401 | $401 | $401 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $955 | $1,001 | $1,047 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $800 | $834 | $869 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $333 | $348 | $362 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $30 | $702 | $1,638 |
| Septoplasty CPT 30520 • ENT | $581 | $897 | $1,638 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $430 | $577 | $772 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $30 | $278 | $581 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $30 | $530 | $931 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $581 | $1,391 | $2,850 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $30 | $990 | $2,850 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $175 | $701 | $1,892 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $30 | $1,164 | $2,850 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $30 | $1,202 | $2,850 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $30 | $252 | $581 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $30 | $1,060 | $3,427 |