| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $80 | $130 | $169 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $61 | $154 | $234 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $67 | $86 | $109 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $117 | $140 | $163 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $90 | $90 | $90 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $50 | $90 | $156 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $91 | $126 | $169 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $115 | $142 | $206 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $141 | $185 | $225 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $171 | $171 | $171 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $143 | $143 | $143 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $277 | $277 | $277 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $167 | $234 | $302 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $244 | $244 | $244 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $75 | $77 | $82 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $68 | $79 | $87 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $2 | $7 | $10 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $107 | $181 | $228 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $75 | $98 | $120 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $87 | $95 | $103 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $75 | $75 | $75 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $205 | $205 | $205 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $30 | $30 | $30 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $10 | $10 | $10 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $67 | $67 | $67 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $69 | $69 | $69 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $126 | $126 | $126 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $29 | $29 | $29 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $15 | $15 | $15 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $179 | $179 | $179 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $1,545 | $1,545 | $1,545 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $42 | $42 | $42 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $362 | $362 | $362 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $271 | $271 | $271 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $1,162 | $1,162 | $1,162 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $588 | $588 | $588 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $245 | $245 | $245 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $556 | $556 | $556 |
| Septoplasty CPT 30520 • ENT | $774 | $774 | $774 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $171 | $171 | $171 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $78 | $138 | $230 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $254 | $254 | $254 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $388 | $388 | $388 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $574 | $574 | $574 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $282 | $282 | $282 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $454 | $454 | $454 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $723 | $723 | $723 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $181 | $181 | $181 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $396 | $396 | $396 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $396 | $405 | $414 |