| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $249 | $249 | $249 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $301 | $301 | $301 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $86 | $96 | $117 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $160 | $160 | $160 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $30 | $75 | $121 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $146 | $146 | $146 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $199 | $199 | $199 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $30 | $101 | $172 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $30 | $152 | $273 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $30 | $99 | $168 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $306 | $306 | $306 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $211 | $294 | $377 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $218 | $316 | $414 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $327 | $327 | $327 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $172 | $172 | $172 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $30 | $83 | $136 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $2 | $8 | $13 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $303 | $303 | $303 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $118 | $118 | $118 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $115 | $170 | $225 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $125 | $125 | $125 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $313 | $313 | $313 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $4 | $14 | $23 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $1 | $4 | $6 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $34 | $39 | $50 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $48 | $57 | $65 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $76 | $248 | $420 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $17 | $72 | $127 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $10 | $34 | $57 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $105 | $336 | $566 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $932 | $3,894 | $6,856 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $20 | $27 | $33 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $241 | $1,612 | $2,411 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $206 | $206 | $206 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $593 | $593 | $593 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $357 | $385 | $412 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $145 | $156 | $167 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $441 | $594 | $748 |
| Septoplasty CPT 30520 • ENT | $1,043 | $1,043 | $1,043 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $230 | $235 | $241 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $331 | $331 | $331 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $575 | $575 | $575 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $502 | $502 | $502 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $743 | $743 | $743 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $194 | $251 | $365 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $586 | $586 | $586 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $936 | $936 | $936 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $28 | $134 | $239 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $516 | $516 | $516 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $540 | $540 | $540 |