| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $62 | $199 | $336 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $417 | $417 | $417 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $92 | $112 | $132 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $327 | $380 | $434 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $102 | $126 | $149 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $177 | $245 | $313 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $295 | $319 | $343 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $65 | $248 | $419 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $71 | $268 | $421 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $284 | $387 | $489 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $328 | $513 | $699 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $398 | $476 | $553 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $152 | $496 | $902 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $545 | $636 | $728 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $70 | $136 | $193 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $66 | $147 | $196 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $3 | $14 | $20 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $371 | $411 | $452 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $85 | $263 | $401 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $327 | $386 | $476 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $310 | $310 | $310 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $418 | $418 | $418 |
| 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 | $55 | $55 | $55 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $29 | $29 | $29 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $52 | $52 | $52 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $13 | $13 | $13 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $6 | $6 | $6 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $69 | $69 | $69 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $604 | $604 | $604 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $20 | $20 | $20 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $1,518 | $1,518 | $1,518 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $220 | $220 | $220 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $576 | $576 | $576 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $478 | $478 | $478 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $199 | $199 | $199 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $167 | $862 | $1,619 |
| Septoplasty CPT 30520 • ENT | $780 | $1,638 | $2,303 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $411 | $624 | $838 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $81 | $451 | $766 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $430 | $618 | $954 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $1,026 | $1,104 | $1,182 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $407 | $928 | $1,506 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $485 | $614 | $743 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $167 | $692 | $1,195 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $1,018 | $1,459 | $1,901 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $168 | $382 | $520 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $361 | $749 | $1,096 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $826 | $982 | $1,137 |