| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $86 | $154 | $222 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $84 | $84 | $84 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $41 | $110 | $178 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $77 | $88 | $100 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $65 | $65 | $65 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $33 | $33 | $33 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $150 | $150 | $150 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $66 | $127 | $188 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $73 | $91 | $109 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $127 | $127 | $127 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $91 | $91 | $91 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $94 | $94 | $94 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $190 | $190 | $190 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $127 | $127 | $127 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $94 | $94 | $94 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $35 | $46 | $57 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $5 | $5 | $6 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $253 | $253 | $253 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $94 | $148 | $202 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $112 | $135 | $158 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $119 | $119 | $119 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $156 | $156 | $156 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $11 | $11 | $11 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $2 | $2 | $2 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $6 | $6 | $6 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $44 | $44 | $44 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $56 | $56 | $56 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $13 | $89 | $165 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $11 | $11 | $11 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $60 | $65 | $70 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $75 | $75 | $75 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $22 | $22 | $22 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $208 | $208 | $208 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $254 | $254 | $254 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $742 | $742 | $742 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $330 | $330 | $330 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $221 | $221 | $221 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $178 | $178 | $178 |
| Septoplasty CPT 30520 • ENT | $430 | $494 | $558 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $230 | $230 | $230 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $114 | $123 | $133 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $192 | $261 | $329 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $180 | $180 | $180 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $568 | $568 | $568 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $113 | $113 | $113 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $311 | $311 | $311 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $376 | $376 | $376 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $144 | $144 | $144 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $443 | $443 | $443 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $194 | $194 | $194 |