| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $96 | $129 | $154 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $166 | $224 | $282 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $108 | $133 | $182 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $30 | $127 | $224 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $76 | $94 | $113 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $30 | $121 | $212 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $153 | $153 | $153 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $280 | $280 | $280 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $218 | $218 | $218 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $253 | $253 | $253 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $30 | $130 | $229 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $429 | $429 | $429 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $30 | $175 | $465 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $240 | $240 | $240 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $30 | $64 | $99 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $125 | $125 | $125 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $2 | $3 | $5 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $282 | $282 | $282 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $30 | $81 | $132 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $30 | $140 | $246 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $120 | $126 | $131 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $129 | $151 | $173 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $6 | $19 | $32 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $2 | $5 | $11 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $13 | $54 | $83 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $35 | $68 | $101 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $134 | $296 | $457 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $30 | $76 | $121 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $4 | $11 | $18 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $54 | $117 | $181 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $1,642 | $3,404 | $5,165 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $52 | $116 | $181 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $205 | $2,035 | $3,849 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $212 | $273 | $334 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $624 | $967 | $1,310 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $394 | $560 | $725 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $182 | $222 | $302 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $30 | $391 | $834 |
| Septoplasty CPT 30520 • ENT | $30 | $608 | $1,187 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $431 | $431 | $431 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $30 | $212 | $394 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $30 | $171 | $312 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $30 | $280 | $530 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $30 | $404 | $777 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $203 | $264 | $385 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $30 | $324 | $617 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $30 | $505 | $980 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $212 | $238 | $265 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $30 | $297 | $564 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $585 | $585 | $585 |