| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $60 | $172 | $283 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $73 | $208 | $343 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $68 | $209 | $351 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $53 | $163 | $273 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $69 | $215 | $360 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $83 | $247 | $410 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $78 | $187 | $295 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $150 | $236 | $322 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $170 | $296 | $421 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $150 | $319 | $489 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $181 | $440 | $699 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $204 | $379 | $553 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $216 | $392 | $568 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $183 | $456 | $728 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $99 | $231 | $363 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $50 | $56 | $62 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $12 | $16 | $20 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $224 | $297 | $371 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $104 | $178 | $252 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $117 | $208 | $298 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $48 | $48 | $48 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $167 | $167 | $167 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $37 | $37 | $37 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $10 | $10 | $10 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $78 | $78 | $78 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $120 | $120 | $120 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $140 | $140 | $140 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $32 | $32 | $32 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $16 | $16 | $16 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $200 | $200 | $200 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $1,716 | $1,716 | $1,716 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $53 | $53 | $53 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $395 | $395 | $395 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $287 | $287 | $287 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $989 | $989 | $989 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $532 | $532 | $532 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $247 | $247 | $247 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $487 | $727 | $967 |
| Septoplasty CPT 30520 • ENT | $614 | $1,033 | $1,451 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $267 | $552 | $838 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $97 | $279 | $460 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $412 | $498 | $584 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $369 | $698 | $1,026 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $547 | $715 | $883 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $267 | $352 | $437 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $431 | $813 | $1,195 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $689 | $1,295 | $1,901 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $214 | $362 | $510 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $354 | $511 | $668 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $383 | $760 | $1,137 |