| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $65 | $128 | $190 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $78 | $85 | $92 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $48 | $99 | $151 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $58 | $65 | $72 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $52 | $106 | $160 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $64 | $120 | $175 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $4 | $97 | $190 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $5 | $119 | $232 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $6 | $132 | $258 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $5 | $108 | $212 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $6 | $6 | $6 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $7 | $178 | $349 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $8 | $192 | $376 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $7 | $157 | $308 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $75 | $122 | $169 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $58 | $77 | $97 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $10 | $34 | $58 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $5 | $123 | $240 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $58 | $77 | $96 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $4 | $101 | $199 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $4 | $4 | $4 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $89 | $89 | $89 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $11 | $11 | $11 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $5 | $5 | $5 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $91 | $91 | $91 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $63 | $70 | $77 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $128 | $128 | $128 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $34 | $34 | $34 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $14 | $14 | $14 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $175 | $175 | $175 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $1,394 | $1,394 | $1,394 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $51 | $51 | $51 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $564 | $564 | $564 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $548 | $548 | $548 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $19 | $695 | $1,371 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $900 | $900 | $900 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $316 | $409 | $503 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $9 | $236 | $463 |
| Septoplasty CPT 30520 • ENT | $978 | $1,427 | $1,876 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $7 | $173 | $339 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $58 | $74 | $90 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $8 | $204 | $399 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $8 | $345 | $683 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $9 | $258 | $507 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $6 | $144 | $282 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $8 | $212 | $416 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $526 | $559 | $592 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $6 | $151 | $295 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $9 | $230 | $451 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $10 | $241 | $472 |