| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $76 | $138 | $200 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $92 | $171 | $250 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $158 | $173 | $180 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $192 | $192 | $192 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $55 | $111 | $166 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $73 | $73 | $73 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $136 | $174 | $211 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $91 | $170 | $249 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $100 | $187 | $275 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $114 | $171 | $227 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $315 | $315 | $315 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $365 | $365 | $365 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $390 | $390 | $390 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $205 | $205 | $205 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $182 | $182 | $182 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $45 | $66 | $88 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $10 | $11 | $12 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $87 | $176 | $266 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $179 | $181 | $183 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $133 | $187 | $213 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $184 | $184 | $184 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $243 | $243 | $243 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $3 | $3 | $3 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $1 | $1 | $1 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $30 | $30 | $30 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $17 | $17 | $17 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $279 | $279 | $279 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $81 | $81 | $81 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $23 | $23 | $23 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $38 | $38 | $38 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $334 | $334 | $334 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $97 | $97 | $97 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $883 | $883 | $883 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $164 | $164 | $164 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $349 | $349 | $349 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $357 | $357 | $357 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $149 | $149 | $149 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $292 | $388 | $493 |
| Septoplasty CPT 30520 • ENT | $1,032 | $1,063 | $1,094 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $195 | $270 | $346 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $106 | $213 | $320 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $262 | $354 | $446 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $398 | $564 | $730 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $474 | $502 | $530 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $176 | $215 | $294 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $283 | $359 | $436 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $45 | $333 | $620 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $174 | $244 | $310 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $445 | $463 | $480 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $501 | $515 | $528 |