| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $95 | $126 | $157 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $47 | $47 | $47 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $45 | $45 | $45 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $63 | $108 | $154 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $27 | $27 | $27 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $30 | $30 | $30 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $77 | $77 | $77 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $95 | $95 | $95 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $80 | $93 | $106 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $86 | $86 | $86 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $119 | $119 | $119 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $147 | $147 | $147 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $162 | $162 | $162 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $127 | $127 | $127 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $67 | $120 | $172 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $53 | $53 | $53 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $5 | $5 | $5 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $119 | $119 | $119 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $73 | $73 | $73 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $87 | $143 | $200 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $51 | $51 | $51 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $54 | $54 | $54 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $23 | $23 | $23 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $6 | $6 | $6 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $49 | $49 | $49 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $10 | $10 | $10 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $76 | $76 | $76 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $17 | $17 | $17 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $10 | $10 | $10 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $105 | $105 | $105 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $932 | $932 | $932 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $34 | $34 | $34 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $2,185 | $2,185 | $2,185 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $194 | $194 | $194 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $593 | $593 | $593 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $359 | $359 | $359 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $167 | $167 | $167 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $315 | $315 | $315 |
| Septoplasty CPT 30520 • ENT | $447 | $447 | $447 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $160 | $160 | $160 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $60 | $73 | $86 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $243 | $341 | $439 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $219 | $219 | $219 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $323 | $323 | $323 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $158 | $158 | $158 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $255 | $259 | $263 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $374 | $391 | $408 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $130 | $130 | $130 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $211 | $309 | $407 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $220 | $322 | $425 |