| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $113 | $223 | $333 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $156 | $279 | $402 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $148 | $148 | $148 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $194 | $194 | $194 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $34 | $92 | $150 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $115 | $148 | $182 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $30 | $154 | $278 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $30 | $178 | $325 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $101 | $183 | $264 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $128 | $227 | $327 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $388 | $388 | $388 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $445 | $445 | $445 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $248 | $287 | $326 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $249 | $249 | $249 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $30 | $123 | $217 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $30 | $62 | $93 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $26 | $28 | $30 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $411 | $411 | $411 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $101 | $108 | $115 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $151 | $151 | $151 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $103 | $103 | $103 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $843 | $843 | $843 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $23 | $23 | $23 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $8 | $8 | $8 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $10 | $10 | $10 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $54 | $54 | $54 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $100 | $100 | $100 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $21 | $21 | $21 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $11 | $11 | $11 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $146 | $146 | $146 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $1,202 | $1,202 | $1,202 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $33 | $33 | $33 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $2,764 | $2,764 | $2,764 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $197 | $197 | $197 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $904 | $904 | $904 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $427 | $427 | $427 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $178 | $178 | $178 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $302 | $447 | $735 |
| Septoplasty CPT 30520 • ENT | $668 | $878 | $1,088 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $310 | $310 | $310 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $199 | $201 | $203 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $274 | $549 | $823 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $763 | $763 | $763 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $1,127 | $1,127 | $1,127 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $172 | $298 | $550 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $30 | $461 | $892 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $362 | $893 | $1,423 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $30 | $221 | $429 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $291 | $516 | $740 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $30 | $415 | $799 |