| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $53 | $198 | $343 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $415 | $415 | $415 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $271 | $271 | $271 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $333 | $333 | $333 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $274 | $274 | $274 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $315 | $315 | $315 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $342 | $342 | $342 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $65 | $194 | $410 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $142 | $299 | $457 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $371 | $371 | $371 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $530 | $530 | $530 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $630 | $630 | $630 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $152 | $418 | $683 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $552 | $552 | $552 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $46 | $156 | $289 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $66 | $125 | $183 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $3 | $9 | $16 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $413 | $413 | $413 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $72 | $165 | $306 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $363 | $363 | $363 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $90 | $90 | $90 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $196 | $196 | $196 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $7 | $7 | $7 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $3 | $3 | $3 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $9 | $35 | $59 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $40 | $46 | $51 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $52 | $52 | $52 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $31 | $31 | $31 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $5 | $5 | $5 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $62 | $62 | $62 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $563 | $563 | $563 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $20 | $20 | $20 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $1,572 | $1,572 | $1,572 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $355 | $355 | $355 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $878 | $878 | $878 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $530 | $544 | $570 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $219 | $225 | $235 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $112 | $661 | $1,210 |
| Septoplasty CPT 30520 • ENT | $780 | $1,242 | $1,705 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $632 | $632 | $632 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $81 | $329 | $578 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $299 | $504 | $708 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $748 | $748 | $748 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $407 | $751 | $1,094 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $542 | $542 | $542 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $250 | $559 | $868 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $1,380 | $1,380 | $1,380 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $168 | $348 | $528 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $361 | $580 | $799 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $834 | $834 | $834 |