| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $195 | $273 | $351 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $157 | $296 | $435 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $30 | $156 | $283 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $30 | $169 | $342 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $30 | $192 | $353 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $30 | $209 | $389 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $30 | $194 | $358 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $30 | $239 | $437 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $139 | $310 | $481 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $30 | $216 | $401 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $30 | $344 | $659 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $640 | $640 | $640 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $191 | $364 | $538 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $421 | $421 | $421 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $30 | $207 | $384 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $30 | $110 | $188 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $9 | $19 | $30 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $30 | $251 | $472 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $30 | $197 | $377 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $103 | $237 | $370 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $134 | $240 | $347 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $468 | $468 | $468 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $8 | $8 | $8 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $3 | $5 | $6 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $47 | $81 | $100 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $10 | $64 | $117 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $94 | $94 | $94 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $24 | $24 | $24 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $10 | $38 | $66 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $126 | $461 | $795 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $1,099 | $1,099 | $1,099 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $37 | $134 | $231 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $2,761 | $2,968 | $3,176 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $401 | $401 | $401 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $1,047 | $1,047 | $1,047 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $577 | $723 | $869 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $161 | $262 | $362 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $30 | $671 | $1,117 |
| Septoplasty CPT 30520 • ENT | $530 | $1,255 | $1,980 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $575 | $575 | $575 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $30 | $310 | $547 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $30 | $405 | $747 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $1,279 | $1,279 | $1,279 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $30 | $486 | $943 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $152 | $338 | $525 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $30 | $402 | $773 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $30 | $565 | $1,101 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $30 | $306 | $562 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $30 | $462 | $854 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $30 | $585 | $1,140 |