| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $153 | $191 | $230 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $30 | $36 | $41 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $30 | $103 | $180 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $30 | $30 | $30 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $30 | $30 | $30 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $30 | $77 | $124 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $30 | $48 | $66 |
| 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 | $30 | $66 | $101 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $30 | $160 | $290 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $222 | $222 | $222 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $45 | $201 | $356 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $30 | $54 | $78 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $30 | $39 | $57 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $6 | $18 | $30 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $30 | $131 | $233 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $30 | $97 | $165 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $14 | $106 | $192 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $112 | $136 | $159 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $214 | $214 | $214 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $7 | $7 | $7 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $2 | $3 | $3 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $70 | $72 | $73 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $39 | $39 | $39 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $359 | $359 | $359 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $13 | $70 | $126 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $76 | $76 | $77 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $60 | $638 | $927 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $5,165 | $5,165 | $5,165 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $270 | $270 | $270 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $1,610 | $1,790 | $1,970 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $284 | $284 | $284 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $405 | $405 | $405 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $799 | $799 | $800 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $175 | $198 | $221 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $30 | $242 | $453 |
| Septoplasty CPT 30520 • ENT | $1,030 | $1,030 | $1,030 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $30 | $157 | $307 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $30 | $250 | $392 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $673 | $673 | $673 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $30 | $252 | $474 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $231 | $231 | $231 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $30 | $30 | $30 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $30 | $529 | $1,027 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $30 | $30 | $30 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $30 | $234 | $438 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $30 | $30 | $30 |
| Tonsillectomy primary under age 12 CPT 42826 • ENT | $384 | $384 | $384 |
| Adenoidectomy primary under age 12 CPT 42830 • ENT | $30 | $175 | $319 |
| Removal impacted cerumen unilateral CPT 69210 • ENT | $36 | $44 | $53 |