| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $27 | $78 | $128 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $31 | $93 | $155 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $16 | $43 | $70 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $8 | $52 | $95 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $7 | $7 | $7 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $56 | $56 | $56 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $85 | $85 | $85 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $22 | $22 | $22 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $88 | $88 | $88 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $134 | $134 | $134 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $38 | $113 | $189 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $23 | $23 | $23 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $50 | $151 | $252 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $200 | $200 | $200 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $56 | $64 | $73 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $8 | $8 | $8 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $1 | $3 | $4 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $18 | $18 | $18 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $7 | $60 | $112 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $18 | $75 | $133 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $77 | $77 | $78 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $39 | $118 | $197 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $10 | $10 | $10 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $4 | $4 | $4 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $6 | $6 | $6 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $45 | $45 | $46 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $51 | $282 | $512 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $143 | $143 | $143 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $56 | $56 | $57 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $89 | $89 | $90 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $4,924 | $5,745 | $6,565 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $13 | $123 | $232 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $2,736 | $2,736 | $2,736 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $67 | $101 | $134 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $54 | $299 | $543 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $33 | $127 | $220 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $22 | $65 | $108 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $488 | $488 | $488 |
| Septoplasty CPT 30520 • ENT | $105 | $401 | $697 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $175 | $213 | $250 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $56 | $134 | $212 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $275 | $321 | $366 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $240 | $280 | $320 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $94 | $281 | $469 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $56 | $144 | $231 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $372 | $372 | $372 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $592 | $592 | $593 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $27 | $27 | $27 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $275 | $333 | $392 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $286 | $286 | $286 |