| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $105 | $131 | $157 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $327 | $327 | $327 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $74 | $74 | $74 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $154 | $207 | $261 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $85 | $85 | $85 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $248 | $248 | $248 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $175 | $175 | $175 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $327 | $327 | $327 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $80 | $162 | $244 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $300 | $300 | $300 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $258 | $258 | $258 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $490 | $490 | $490 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $347 | $347 | $347 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $268 | $268 | $268 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $172 | $205 | $238 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $140 | $140 | $140 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $13 | $13 | $13 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $339 | $339 | $339 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $239 | $239 | $239 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $200 | $240 | $281 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $247 | $247 | $247 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $351 | $351 | $351 |
| 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 | $31 | $31 | $31 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $22 | $22 | $22 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $27 | $27 | $27 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $7 | $7 | $7 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $3 | $3 | $3 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $35 | $35 | $35 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $312 | $312 | $312 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $11 | $11 | $11 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $806 | $806 | $806 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $154 | $154 | $154 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $441 | $441 | $441 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $235 | $235 | $235 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $107 | $107 | $107 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $603 | $603 | $603 |
| Septoplasty CPT 30520 • ENT | $1,377 | $1,377 | $1,377 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $465 | $465 | $465 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $86 | $249 | $413 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $337 | $388 | $439 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $897 | $897 | $897 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $689 | $689 | $689 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $383 | $383 | $383 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $263 | $414 | $564 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $374 | $589 | $805 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $408 | $408 | $408 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $407 | $511 | $614 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $425 | $533 | $641 |