| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $53 | $139 | $303 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $87 | $227 | $367 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $14 | $14 | $14 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $59 | $59 | $59 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $51 | $51 | $51 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $57 | $57 | $57 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $145 | $168 | $191 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $65 | $155 | $245 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $87 | $145 | $206 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $212 | $229 | $246 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $101 | $101 | $101 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $346 | $447 | $548 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $69 | $337 | $590 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $307 | $336 | $364 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $70 | $121 | $167 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $24 | $51 | $66 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $1 | $6 | $14 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $83 | $83 | $83 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $57 | $147 | $269 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $199 | $276 | $315 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $233 | $233 | $233 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $126 | $126 | $126 |
| 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 | $51 | $51 | $51 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $64 | $64 | $64 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $460 | $460 | $460 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $102 | $102 | $102 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $9 | $9 | $9 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $597 | $597 | $597 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $555 | $555 | $555 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $119 | $119 | $119 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $2,238 | $2,238 | $2,238 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $280 | $280 | $280 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $630 | $630 | $630 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $456 | $456 | $456 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $226 | $226 | $226 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $112 | $598 | $904 |
| Septoplasty CPT 30520 • ENT | $399 | $905 | $1,536 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $92 | $92 | $92 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $81 | $225 | $466 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $174 | $323 | $470 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $132 | $567 | $1,002 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $407 | $580 | $802 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $295 | $378 | $419 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $167 | $412 | $637 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $204 | $541 | $879 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $168 | $328 | $459 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $138 | $392 | $678 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $61 | $103 | $144 |