| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $57 | $167 | $277 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $57 | $117 | $178 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $57 | $134 | $211 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $57 | $120 | $184 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $57 | $130 | $204 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $233 | $6,854 | $13,476 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $278 | $6,877 | $13,476 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $307 | $6,891 | $13,476 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $258 | $6,867 | $13,476 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $356 | $6,916 | $13,476 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $405 | $6,941 | $13,476 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $429 | $6,952 | $13,476 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $364 | $6,920 | $13,476 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $57 | $128 | $200 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $57 | $88 | $119 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $5 | $31 | $57 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $57 | $100 | $144 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $57 | $131 | $205 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $57 | $147 | $237 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $224 | $224 | $224 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $257 | $257 | $257 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $32 | $32 | $32 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $246 | $246 | $246 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $266 | $266 | $266 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $838 | $838 | $838 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $436 | $436 | $436 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $215 | $215 | $215 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $514 | $14,515 | $28,516 |
| Septoplasty CPT 30520 • ENT | $1,057 | $17,437 | $33,816 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $405 | $10,044 | $19,682 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $57 | $206 | $356 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $469 | $14,492 | $28,516 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $768 | $23,376 | $45,983 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $436 | $21,600 | $42,765 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $236 | $23,109 | $45,983 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $346 | $23,165 | $45,983 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $549 | $23,266 | $45,983 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $355 | $10,018 | $19,682 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $425 | $23,204 | $45,983 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $444 | $21,605 | $42,765 |
| Tonsillectomy primary under age 12 CPT 42826 • ENT | $383 | $17,100 | $33,816 |
| Adenoidectomy primary under age 12 CPT 42830 • ENT | $328 | $17,072 | $33,816 |
| Removal impacted cerumen unilateral CPT 69210 • ENT | $57 | $69 | $82 |
| Tympanostomy tube insertion CPT 69436 • ENT | $242 | $23,113 | $45,983 |
| Tympanoplasty without mastoidectomy CPT 69631 • ENT | $1,360 | $22,062 | $42,765 |
| Tympanoplasty with mastoidectomy CPT 69633 • ENT | $1,591 | $22,178 | $42,765 |
| Comprehensive audiometry evaluation CPT 92557 • ENT | $61 | $61 | $61 |
| Incision and drainage abscess simple CPT 10060 • Emergency | $57 | $143 | $229 |
| Incision and drainage abscess complicated CPT 10061 • Emergency | $57 | $219 | $382 |
| Simple wound repair up to 2.5cm CPT 12001 • Emergency | $57 | $130 | $203 |