| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $50 | $83 | $100 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $49 | $88 | $122 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $40 | $66 | $80 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $48 | $80 | $97 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $17 | $50 | $84 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $18 | $28 | $39 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $10 | $58 | $100 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $61 | $101 | $122 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $67 | $101 | $136 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $78 | $95 | $111 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $109 | $140 | $157 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $121 | $128 | $135 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $63 | $129 | $192 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $68 | $85 | $102 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $41 | $65 | $89 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $6 | $36 | $52 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $0 | $3 | $5 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $8 | $67 | $126 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $8 | $61 | $88 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $15 | $74 | $104 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $21 | $72 | $106 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $55 | $92 | $148 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $5 | $5 | $5 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $2 | $2 | $2 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $11 | $39 | $61 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $37 | $42 | $49 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $49 | $375 | $615 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $12 | $110 | $159 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $5 | $42 | $68 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $63 | $571 | $826 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $573 | $4,384 | $7,188 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $19 | $75 | $181 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $270 | $1,246 | $2,031 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $38 | $146 | $210 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $54 | $438 | $823 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $205 | $331 | $456 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $34 | $132 | $190 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $54 | $157 | $270 |
| Septoplasty CPT 30520 • ENT | $62 | $399 | $615 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $21 | $132 | $205 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $44 | $125 | $178 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $109 | $158 | $234 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $22 | $254 | $400 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $30 | $198 | $296 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $149 | $160 | $165 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $24 | $162 | $242 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $69 | $243 | $346 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $90 | $122 | $153 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $39 | $178 | $259 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $203 | $240 | $271 |