| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $119 | $169 | $326 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $144 | $164 | $224 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $41 | $51 | $82 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $46 | $121 | $317 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $30 | $49 | $83 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $39 | $106 | $303 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $41 | $85 | $218 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $41 | $126 | $276 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $41 | $117 | $207 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $93 | $170 | $373 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $41 | $85 | $215 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $41 | $225 | $594 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $41 | $190 | $637 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $328 | $328 | $328 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $41 | $66 | $141 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $41 | $83 | $174 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $4 | $26 | $41 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $41 | $170 | $438 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $41 | $112 | $294 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $41 | $66 | $141 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $57 | $69 | $73 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $177 | $274 | $468 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $3 | $3 | $3 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $17 | $17 | $17 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $33 | $35 | $40 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $4 | $31 | $44 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $214 | $214 | $214 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $46 | $46 | $46 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $4 | $4 | $4 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $50 | $50 | $50 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $440 | $440 | $440 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $15 | $15 | $15 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $5,923 | $5,923 | $5,923 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $160 | $221 | $251 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $419 | $667 | $791 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $411 | $537 | $915 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $145 | $189 | $203 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $41 | $225 | $776 |
| Septoplasty CPT 30520 • ENT | $41 | $229 | $604 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $41 | $189 | $399 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $41 | $93 | $250 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $41 | $145 | $457 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $41 | $169 | $424 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $41 | $242 | $845 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $41 | $148 | $470 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $41 | $217 | $495 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $41 | $228 | $791 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $41 | $156 | $356 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $41 | $134 | $411 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $41 | $205 | $444 |