| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $71 | $134 | $199 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $211 | $211 | $211 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $30 | $49 | $67 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $30 | $85 | $163 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $40 | $63 | $88 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $44 | $95 | $156 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $71 | $125 | $166 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $133 | $174 | $250 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $30 | $124 | $203 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $30 | $96 | $131 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $231 | $231 | $231 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $30 | $111 | $192 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $167 | $238 | $310 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $245 | $245 | $245 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $30 | $45 | $74 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $30 | $62 | $102 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $8 | $19 | $30 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $209 | $216 | $224 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $30 | $111 | $185 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $87 | $98 | $110 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $85 | $85 | $85 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $91 | $91 | $91 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $8 | $15 | $21 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $3 | $5 | $7 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $35 | $69 | $96 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $58 | $89 | $117 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $76 | $99 | $122 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $17 | $24 | $30 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $10 | $12 | $15 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $104 | $136 | $169 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $932 | $1,183 | $1,435 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $29 | $38 | $47 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $533 | $1,359 | $2,185 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $190 | $300 | $411 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $774 | $1,008 | $1,241 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $412 | $652 | $892 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $172 | $272 | $372 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $551 | $834 | $1,117 |
| Septoplasty CPT 30520 • ENT | $530 | $624 | $791 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $170 | $198 | $225 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $102 | $211 | $352 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $246 | $352 | $439 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $344 | $358 | $373 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $548 | $548 | $548 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $269 | $269 | $269 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $30 | $289 | $434 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $692 | $692 | $692 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $179 | $221 | $326 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $324 | $385 | $504 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $30 | $262 | $405 |