| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $22 | $63 | $104 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $11 | $69 | $127 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $45 | $64 | $83 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $45 | $74 | $102 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $5 | $44 | $83 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $97 | $97 | $97 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $35 | $52 | $69 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $14 | $29 | $45 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $50 | $74 | $99 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $44 | $45 | $45 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $21 | $92 | $163 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $147 | $147 | $147 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $144 | $178 | $212 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $110 | $110 | $110 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $45 | $45 | $45 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $34 | $40 | $45 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $5 | $5 | $5 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $128 | $128 | $128 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $45 | $69 | $93 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $17 | $64 | $111 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $11 | $34 | $56 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $41 | $82 | $123 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $7 | $7 | $8 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $3 | $3 | $3 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $46 | $46 | $47 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $27 | $27 | $28 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $35 | $195 | $354 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $75 | $88 | $100 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $25 | $28 | $32 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $412 | $412 | $412 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $399 | $2,197 | $3,994 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $14 | $60 | $106 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $159 | $674 | $1,189 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $87 | $131 | $174 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $683 | $683 | $683 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $38 | $38 | $38 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $32 | $94 | $157 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $265 | $322 | $378 |
| Septoplasty CPT 30520 • ENT | $81 | $311 | $540 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $146 | $170 | $194 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $6 | $92 | $178 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $107 | $165 | $223 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $37 | $140 | $243 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $178 | $267 | $356 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $88 | $132 | $176 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $28 | $28 | $28 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $225 | $225 | $225 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $63 | $118 | $173 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $40 | $155 | $269 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $28 | $28 | $28 |