| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $215 | $272 | $330 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $166 | $276 | $335 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $67 | $81 | $95 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $163 | $237 | $311 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $56 | $56 | $56 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $67 | $111 | $156 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $169 | $245 | $322 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $118 | $160 | $202 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $225 | $265 | $306 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $276 | $276 | $276 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $506 | $506 | $506 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $117 | $117 | $117 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $167 | $408 | $650 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $154 | $154 | $154 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $142 | $142 | $142 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $72 | $135 | $198 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $8 | $17 | $26 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $209 | $301 | $393 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $150 | $218 | $286 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $87 | $92 | $97 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $165 | $165 | $165 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $372 | $372 | $372 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $50 | $50 | $50 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $17 | $17 | $17 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $24 | $24 | $24 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $58 | $58 | $58 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $212 | $212 | $212 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $27 | $27 | $27 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $9 | $9 | $9 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $160 | $160 | $160 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $2,589 | $2,589 | $2,589 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $26 | $26 | $26 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $910 | $910 | $910 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $296 | $296 | $296 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $710 | $710 | $710 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $643 | $643 | $643 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $268 | $268 | $268 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $1,417 | $1,417 | $1,417 |
| Septoplasty CPT 30520 • ENT | $2,024 | $2,024 | $2,024 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $442 | $442 | $442 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $666 | $666 | $666 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $833 | $833 | $833 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $900 | $900 | $900 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $460 | $460 | $460 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $651 | $651 | $651 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $1,047 | $1,047 | $1,047 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $1,667 | $1,667 | $1,667 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $706 | $706 | $706 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $1,089 | $1,089 | $1,089 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $1,131 | $1,131 | $1,131 |