| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $198 | $198 | $198 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $240 | $240 | $240 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $45 | $83 | $158 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $45 | $119 | $192 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $77 | $87 | $97 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $114 | $114 | $114 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $64 | $143 | $222 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $250 | $250 | $250 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $131 | $158 | $184 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $248 | $248 | $248 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $45 | $120 | $195 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $548 | $548 | $548 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $45 | $176 | $437 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $45 | $183 | $322 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $98 | $98 | $98 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $51 | $103 | $156 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $14 | $14 | $14 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $45 | $211 | $377 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $45 | $103 | $161 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $45 | $107 | $232 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $266 | $266 | $266 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $380 | $380 | $380 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $5 | $5 | $5 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $2 | $2 | $2 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $11 | $38 | $59 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $6 | $20 | $34 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $52 | $245 | $439 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $13 | $68 | $124 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $5 | $18 | $31 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $63 | $221 | $379 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $601 | $2,780 | $4,958 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $20 | $97 | $174 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $216 | $1,221 | $1,970 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $232 | $232 | $232 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $823 | $823 | $823 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $419 | $431 | $456 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $175 | $182 | $190 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $45 | $483 | $725 |
| Septoplasty CPT 30520 • ENT | $1,552 | $1,605 | $1,658 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $384 | $384 | $384 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $155 | $307 | $458 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $282 | $452 | $623 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $1,008 | $1,041 | $1,075 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $578 | $684 | $790 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $45 | $177 | $440 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $473 | $559 | $646 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $337 | $631 | $925 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $45 | $277 | $458 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $513 | $611 | $709 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $730 | $735 | $740 |