| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $199 | $301 | $403 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $488 | $488 | $488 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $319 | $319 | $319 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $391 | $391 | $391 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $322 | $322 | $322 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $371 | $371 | $371 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $403 | $403 | $403 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $107 | $280 | $483 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $139 | $338 | $537 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $436 | $436 | $436 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $623 | $623 | $623 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $741 | $741 | $741 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $804 | $804 | $804 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $650 | $650 | $650 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $46 | $193 | $340 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $111 | $164 | $216 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $9 | $14 | $18 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $486 | $486 | $486 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $116 | $220 | $360 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $427 | $427 | $427 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $106 | $106 | $106 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $230 | $230 | $230 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $7 | $7 | $8 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $3 | $3 | $3 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $38 | $58 | $96 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $4 | $71 | $117 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $52 | $87 | $122 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $30 | $31 | $31 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $5 | $10 | $15 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $62 | $115 | $169 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $563 | $999 | $1,435 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $20 | $33 | $47 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $236 | $385 | $533 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $355 | $383 | $411 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $878 | $1,060 | $1,241 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $530 | $544 | $570 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $219 | $275 | $372 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $1,117 | $1,270 | $1,423 |
| Septoplasty CPT 30520 • ENT | $530 | $1,268 | $2,005 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $743 | $743 | $743 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $352 | $516 | $680 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $439 | $636 | $833 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $880 | $880 | $880 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $1,287 | $1,287 | $1,287 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $637 | $637 | $637 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $1,021 | $1,021 | $1,021 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $1,623 | $1,623 | $1,623 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $326 | $474 | $621 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $504 | $722 | $940 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $981 | $981 | $981 |