| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $39 | $115 | $192 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $232 | $232 | $232 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $108 | $108 | $108 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $78 | $78 | $78 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $52 | $52 | $52 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $67 | $67 | $67 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $33 | $76 | $120 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $100 | $163 | $227 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $183 | $218 | $252 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $205 | $205 | $205 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $289 | $289 | $289 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $33 | $192 | $351 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $226 | $234 | $252 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $306 | $306 | $306 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $80 | $84 | $87 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $41 | $64 | $87 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $7 | $20 | $33 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $271 | $271 | $271 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $74 | $91 | $108 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $134 | $134 | $134 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $114 | $114 | $114 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $105 | $105 | $105 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $58 | $58 | $58 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $18 | $18 | $18 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $25 | $25 | $25 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $25 | $25 | $25 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $190 | $190 | $190 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $43 | $43 | $43 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $25 | $25 | $25 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $260 | $260 | $260 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $2,328 | $2,328 | $2,328 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $84 | $84 | $84 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $5,457 | $5,457 | $5,457 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $627 | $627 | $627 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $1,617 | $1,617 | $1,617 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $1,007 | $1,007 | $1,007 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $416 | $416 | $416 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $370 | $531 | $692 |
| Septoplasty CPT 30520 • ENT | $569 | $769 | $969 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $362 | $362 | $362 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $143 | $225 | $306 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $284 | $293 | $301 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $430 | $430 | $430 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $630 | $630 | $630 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $312 | $312 | $312 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $446 | $473 | $500 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $794 | $794 | $794 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $302 | $302 | $302 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $460 | $460 | $460 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $479 | $479 | $479 |