| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $50 | $127 | $165 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $60 | $60 | $60 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $94 | $94 | $94 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $121 | $121 | $121 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $66 | $66 | $66 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $116 | $116 | $116 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $109 | $150 | $170 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $160 | $192 | $207 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $164 | $207 | $228 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $102 | $102 | $102 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $205 | $205 | $205 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $144 | $144 | $144 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $211 | $211 | $211 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $123 | $123 | $123 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $79 | $109 | $153 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $77 | $77 | $77 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $7 | $7 | $7 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $96 | $96 | $96 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $115 | $139 | $151 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $135 | $163 | $176 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $46 | $46 | $46 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $128 | $128 | $128 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $6 | $6 | $6 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $3 | $3 | $3 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $15 | $15 | $15 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $12 | $12 | $12 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $96 | $96 | $96 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $24 | $24 | $24 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $12 | $12 | $12 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $133 | $133 | $133 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $37 | $37 | $37 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $420 | $420 | $420 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $322 | $322 | $322 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $977 | $977 | $977 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $699 | $699 | $699 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $311 | $311 | $311 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $392 | $409 | $443 |
| Septoplasty CPT 30520 • ENT | $614 | $804 | $900 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $136 | $136 | $136 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $118 | $204 | $247 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $170 | $170 | $170 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $398 | $398 | $398 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $296 | $296 | $296 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $175 | $220 | $244 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $341 | $348 | $352 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $501 | $605 | $812 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $203 | $238 | $256 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $329 | $371 | $392 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $409 | $428 | $465 |
| Tonsillectomy primary under age 12 CPT 42826 • ENT | $344 | $357 | $384 |