| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $168 | $245 | $323 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $203 | $303 | $403 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $33 | $90 | $118 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $92 | $200 | $309 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $43 | $46 | $50 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $49 | $92 | $136 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $50 | $96 | $142 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $50 | $105 | $161 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $125 | $129 | $133 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $50 | $105 | $161 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $108 | $108 | $108 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $142 | $206 | $270 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $223 | $383 | $632 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $187 | $187 | $187 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $50 | $70 | $91 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $50 | $64 | $78 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $10 | $30 | $50 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $210 | $227 | $244 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $51 | $174 | $297 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $128 | $210 | $346 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $72 | $94 | $115 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $178 | $274 | $370 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $31 | $31 | $31 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $9 | $9 | $9 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $62 | $62 | $62 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $96 | $96 | $96 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $134 | $134 | $134 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $29 | $29 | $29 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $13 | $13 | $13 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $183 | $183 | $183 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $1,373 | $1,373 | $1,373 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $44 | $44 | $44 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $3,159 | $3,159 | $3,159 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $298 | $298 | $298 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $862 | $862 | $862 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $478 | $559 | $600 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $197 | $231 | $248 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $486 | $599 | $767 |
| Septoplasty CPT 30520 • ENT | $695 | $1,142 | $1,588 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $224 | $297 | $370 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $189 | $353 | $517 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $371 | $534 | $697 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $435 | $789 | $1,142 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $649 | $659 | $669 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $233 | $259 | $310 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $372 | $441 | $510 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $50 | $436 | $822 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $213 | $258 | $304 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $422 | $540 | $658 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $439 | $451 | $462 |