| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $20 | $60 | $101 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $25 | $73 | $122 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $5 | $41 | $77 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $70 | $82 | $93 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $12 | $12 | $12 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $18 | $18 | $18 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $33 | $65 | $97 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $115 | $115 | $115 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $33 | $33 | $33 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $12 | $45 | $79 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $68 | $108 | $148 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $18 | $18 | $18 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $12 | $101 | $190 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $9 | $82 | $155 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $18 | $47 | $76 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $38 | $39 | $40 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $0 | $1 | $1 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $75 | $75 | $75 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $5 | $46 | $87 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $33 | $67 | $102 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $15 | $45 | $75 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $10 | $83 | $157 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $5 | $5 | $6 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $2 | $4 | $6 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $9 | $22 | $36 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $63 | $63 | $63 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $74 | $406 | $739 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $17 | $92 | $167 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $98 | $98 | $98 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $746 | $871 | $995 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $9,031 | $9,031 | $9,032 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $32 | $138 | $244 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $318 | $1,746 | $3,175 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $24 | $134 | $243 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $602 | $602 | $602 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $39 | $39 | $39 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $32 | $97 | $161 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $53 | $204 | $355 |
| Septoplasty CPT 30520 • ENT | $98 | $295 | $491 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $32 | $55 | $77 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $25 | $98 | $172 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $62 | $133 | $205 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $33 | $120 | $208 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $304 | $304 | $305 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $33 | $92 | $152 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $49 | $145 | $242 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $288 | $288 | $288 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $28 | $30 | $32 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $33 | $161 | $289 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $60 | $60 | $60 |