| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $336 | $336 | $336 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $153 | $285 | $417 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $100 | $157 | $271 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $119 | $293 | $434 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $105 | $250 | $360 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $114 | $279 | $410 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $125 | $266 | $449 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $153 | $318 | $419 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $461 | $531 | $601 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $140 | $268 | $379 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $193 | $474 | $699 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $613 | $722 | $832 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $238 | $524 | $902 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $463 | $504 | $545 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $79 | $250 | $363 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $65 | $147 | $196 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $0 | $13 | $20 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $164 | $329 | $452 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $110 | $230 | $401 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $129 | $320 | $476 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $112 | $211 | $310 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $418 | $418 | $418 |
| 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 | $55 | $64 | $73 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $40 | $40 | $40 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $52 | $52 | $52 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $13 | $13 | $13 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $6 | $41 | $77 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $69 | $498 | $927 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $604 | $604 | $604 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $20 | $145 | $270 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $1,518 | $2,280 | $3,041 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $220 | $220 | $220 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $576 | $576 | $576 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $478 | $639 | $800 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $199 | $266 | $333 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $291 | $797 | $1,619 |
| Septoplasty CPT 30520 • ENT | $1,831 | $2,067 | $2,303 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $411 | $624 | $838 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $184 | $485 | $766 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $250 | $632 | $954 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $1,026 | $1,104 | $1,182 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $317 | $898 | $1,506 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $175 | $279 | $485 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $259 | $723 | $1,195 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $370 | $1,096 | $1,901 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $188 | $406 | $520 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $285 | $723 | $1,096 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $297 | $754 | $1,137 |