| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $38 | $74 | $109 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $55 | $93 | $132 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $41 | $75 | $143 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $76 | $99 | $121 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $40 | $40 | $41 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $41 | $78 | $115 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $41 | $58 | $76 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $108 | $163 | $218 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $41 | $99 | $157 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $143 | $143 | $143 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $150 | $153 | $157 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $138 | $138 | $138 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $41 | $123 | $200 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $99 | $114 | $130 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $41 | $64 | $86 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $41 | $46 | $51 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $3 | $22 | $41 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $98 | $98 | $98 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $91 | $92 | $94 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $27 | $86 | $123 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $65 | $86 | $107 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $61 | $111 | $161 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $5 | $7 | $10 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $2 | $3 | $4 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $6 | $30 | $49 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $35 | $40 | $44 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $48 | $280 | $512 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $12 | $77 | $143 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $5 | $20 | $34 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $63 | $76 | $89 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $370 | $2,251 | $4,132 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $14 | $16 | $17 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $1,154 | $1,869 | $2,226 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $208 | $229 | $250 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $630 | $711 | $791 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $41 | $265 | $411 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $41 | $137 | $203 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $41 | $266 | $401 |
| Septoplasty CPT 30520 • ENT | $499 | $594 | $690 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $205 | $205 | $205 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $158 | $169 | $181 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $242 | $254 | $266 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $221 | $227 | $234 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $302 | $313 | $324 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $41 | $83 | $168 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $251 | $251 | $251 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $41 | $220 | $399 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $41 | $70 | $127 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $249 | $259 | $268 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $280 | $280 | $280 |