| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $148 | $206 | $264 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $94 | $94 | $94 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $61 | $83 | $119 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $88 | $145 | $257 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $223 | $223 | $223 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $29 | $29 | $29 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $36 | $144 | $269 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $36 | $183 | $329 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $36 | $240 | $362 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $86 | $86 | $86 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $416 | $416 | $416 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $482 | $482 | $482 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $152 | $195 | $216 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $266 | $266 | $266 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $71 | $156 | $243 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $36 | $85 | $141 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $4 | $12 | $15 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $60 | $60 | $60 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $36 | $114 | $178 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $115 | $170 | $279 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $71 | $71 | $71 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $334 | $334 | $334 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $5 | $5 | $5 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $2 | $2 | $2 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $34 | $57 | $79 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $4 | $4 | $4 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $38 | $38 | $38 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $12 | $12 | $12 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $4 | $4 | $4 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $61 | $61 | $61 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $525 | $525 | $525 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $15 | $15 | $15 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $1,385 | $1,385 | $1,385 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $160 | $160 | $160 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $630 | $630 | $630 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $342 | $342 | $342 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $145 | $145 | $145 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $349 | $443 | $629 |
| Septoplasty CPT 30520 • ENT | $799 | $1,119 | $1,438 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $134 | $134 | $134 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $119 | $187 | $221 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $98 | $207 | $300 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $260 | $260 | $260 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $685 | $685 | $685 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $112 | $233 | $354 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $36 | $171 | $311 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $235 | $374 | $444 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $409 | $409 | $409 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $179 | $287 | $342 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $187 | $300 | $357 |