| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $30 | $30 | $30 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $94 | $123 | $153 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $21 | $50 | $100 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $30 | $52 | $75 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $24 | $27 | $30 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $30 | $51 | $71 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $30 | $53 | $80 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $30 | $62 | $94 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $71 | $71 | $71 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $30 | $58 | $86 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $30 | $76 | $121 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $141 | $141 | $141 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $30 | $91 | $152 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $78 | $78 | $78 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $30 | $31 | $34 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $30 | $35 | $40 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $2 | $12 | $30 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $30 | $64 | $97 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $30 | $69 | $109 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $51 | $90 | $129 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $71 | $92 | $112 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $41 | $41 | $41 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $5 | $6 | $8 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $2 | $3 | $3 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $9 | $52 | $73 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $5 | $29 | $53 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $47 | $369 | $690 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $12 | $95 | $178 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $5 | $53 | $77 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $61 | $360 | $927 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $525 | $4,298 | $8,071 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $17 | $186 | $270 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $304 | $1,577 | $3,041 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $208 | $208 | $208 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $630 | $630 | $630 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $342 | $647 | $800 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $169 | $251 | $333 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $30 | $102 | $175 |
| Septoplasty CPT 30520 • ENT | $399 | $399 | $399 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $134 | $142 | $150 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $30 | $35 | $39 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $30 | $64 | $98 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $260 | $260 | $260 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $30 | $116 | $202 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $112 | $154 | $175 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $30 | $97 | $165 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $30 | $133 | $235 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $30 | $59 | $118 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $30 | $104 | $179 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $30 | $108 | $187 |