| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $40 | $89 | $137 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $124 | $147 | $166 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $30 | $78 | $103 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $30 | $61 | $124 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $30 | $69 | $108 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $30 | $51 | $94 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $30 | $66 | $102 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $30 | $77 | $124 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $175 | $175 | $175 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $30 | $72 | $114 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $30 | $73 | $160 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $232 | $232 | $232 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $30 | $64 | $132 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $127 | $134 | $141 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $30 | $35 | $45 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $30 | $41 | $53 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $7 | $18 | $30 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $30 | $79 | $128 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $30 | $50 | $91 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $30 | $88 | $129 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $94 | $109 | $120 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $132 | $153 | $173 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $3 | $5 | $6 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $2 | $3 | $3 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $13 | $39 | $73 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $5 | $20 | $35 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $38 | $247 | $457 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $12 | $67 | $121 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $4 | $52 | $77 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $63 | $361 | $927 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $573 | $2,869 | $5,165 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $20 | $106 | $270 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $167 | $1,171 | $3,041 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $212 | $212 | $212 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $419 | $419 | $419 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $397 | $599 | $800 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $172 | $229 | $333 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $30 | $121 | $303 |
| Septoplasty CPT 30520 • ENT | $30 | $278 | $527 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $117 | $134 | $150 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $30 | $72 | $157 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $30 | $107 | $262 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $30 | $138 | $245 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $30 | $109 | $266 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $148 | $166 | $175 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $30 | $149 | $267 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $30 | $205 | $381 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $30 | $93 | $156 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $30 | $119 | $297 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $30 | $138 | $246 |