| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $7 | $94 | $123 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $76 | $133 | $152 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $30 | $76 | $99 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $30 | $97 | $119 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $30 | $49 | $104 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $30 | $58 | $113 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $19 | $58 | $124 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $30 | $99 | $152 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $30 | $94 | $167 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $30 | $82 | $139 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $30 | $138 | $193 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $22 | $91 | $222 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $30 | $155 | $237 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $30 | $105 | $198 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $8 | $39 | $78 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $13 | $36 | $65 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $1 | $12 | $30 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $30 | $119 | $163 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $16 | $44 | $64 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $30 | $85 | $128 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $22 | $90 | $112 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $9 | $116 | $152 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $8 | $8 | $8 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $3 | $3 | $3 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $13 | $43 | $73 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $39 | $50 | $53 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $69 | $535 | $691 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $134 | $167 | $178 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $7 | $54 | $76 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $927 | $927 | $927 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $807 | $6,255 | $8,071 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $27 | $192 | $270 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $2,280 | $2,851 | $3,041 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $55 | $290 | $368 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $203 | $744 | $1,015 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $799 | $799 | $800 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $33 | $258 | $333 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $35 | $227 | $291 |
| Septoplasty CPT 30520 • ENT | $30 | $373 | $665 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $30 | $119 | $215 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $18 | $104 | $183 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $30 | $140 | $250 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $24 | $229 | $431 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $238 | $297 | $317 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $30 | $81 | $175 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $30 | $147 | $259 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $30 | $145 | $369 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $30 | $103 | $188 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $30 | $203 | $284 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $30 | $145 | $297 |