| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $32 | $86 | $139 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $106 | $137 | $169 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $60 | $94 | $111 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $35 | $41 | $48 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $61 | $61 | $61 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $71 | $100 | $129 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $48 | $53 | $58 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $74 | $74 | $74 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $73 | $73 | $73 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $98 | $98 | $98 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $48 | $84 | $120 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $107 | $107 | $107 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $48 | $169 | $284 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $80 | $80 | $80 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $40 | $40 | $40 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $41 | $51 | $60 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $4 | $4 | $4 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $94 | $94 | $94 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $48 | $63 | $78 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $48 | $93 | $150 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $79 | $101 | $124 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $42 | $113 | $184 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $5 | $6 | $7 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $2 | $3 | $3 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $9 | $23 | $49 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $28 | $29 | $29 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $49 | $162 | $274 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $23 | $63 | $103 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $3 | $3 | $4 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $63 | $189 | $316 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $422 | $2,277 | $4,132 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $19 | $82 | $145 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $177 | $1,153 | $1,641 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $203 | $206 | $210 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $823 | $823 | $823 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $437 | $440 | $441 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $182 | $183 | $184 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $48 | $212 | $316 |
| Septoplasty CPT 30520 • ENT | $48 | $255 | $461 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $101 | $101 | $101 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $48 | $88 | $128 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $48 | $114 | $180 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $48 | $114 | $179 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $48 | $144 | $239 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $128 | $185 | $214 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $195 | $195 | $195 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $327 | $327 | $327 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $136 | $176 | $216 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $48 | $117 | $186 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $219 | $219 | $219 |