| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $7 | $56 | $105 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $127 | $127 | $127 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $39 | $45 | $52 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $14 | $43 | $71 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $40 | $40 | $40 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $40 | $40 | $40 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $89 | $89 | $89 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $60 | $60 | $60 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $86 | $86 | $86 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $40 | $40 | $40 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $40 | $90 | $139 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $34 | $34 | $34 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $131 | $159 | $187 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $98 | $98 | $98 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $40 | $40 | $40 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $4 | $22 | $40 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $1 | $3 | $5 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $22 | $22 | $22 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $8 | $45 | $82 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $20 | $59 | $98 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $50 | $50 | $50 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $130 | $130 | $131 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $23 | $23 | $23 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $6 | $6 | $6 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $8 | $23 | $38 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $10 | $30 | $51 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $635 | $635 | $636 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $108 | $125 | $143 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $63 | $74 | $84 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $87 | $368 | $649 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $777 | $4,272 | $7,767 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $183 | $213 | $243 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $182 | $182 | $182 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $221 | $221 | $221 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $90 | $90 | $90 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $480 | $480 | $480 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $20 | $110 | $200 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $231 | $280 | $329 |
| Septoplasty CPT 30520 • ENT | $479 | $479 | $480 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $51 | $51 | $51 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $21 | $82 | $142 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $152 | $201 | $251 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $115 | $173 | $230 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $169 | $254 | $338 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $33 | $100 | $166 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $40 | $40 | $40 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $64 | $64 | $64 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $40 | $58 | $77 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $24 | $130 | $237 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $173 | $173 | $173 |