| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $102 | $196 | $277 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $236 | $265 | $335 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $78 | $176 | $226 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $100 | $212 | $260 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $44 | $147 | $217 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $76 | $138 | $235 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $44 | $153 | $255 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $158 | $259 | $345 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $44 | $202 | $364 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $62 | $208 | $277 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $270 | $270 | $270 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $315 | $430 | $502 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $246 | $443 | $576 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $442 | $442 | $442 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $42 | $141 | $222 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $44 | $106 | $166 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $5 | $27 | $57 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $165 | $275 | $359 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $112 | $199 | $240 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $130 | $252 | $304 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $93 | $111 | $128 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $288 | $288 | $288 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $31 | $31 | $31 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $11 | $11 | $11 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $15 | $15 | $15 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $72 | $76 | $78 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $94 | $113 | $132 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $22 | $26 | $30 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $18 | $25 | $33 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $121 | $150 | $178 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $1,618 | $1,618 | $1,618 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $36 | $43 | $51 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $3,793 | $3,793 | $3,793 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $329 | $329 | $329 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $1,291 | $1,291 | $1,291 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $591 | $651 | $715 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $298 | $298 | $298 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $319 | $772 | $990 |
| Septoplasty CPT 30520 • ENT | $632 | $1,156 | $1,415 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $309 | $453 | $525 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $184 | $371 | $466 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $273 | $475 | $582 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $331 | $528 | $629 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $166 | $693 | $923 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $82 | $378 | $467 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $64 | $450 | $731 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $44 | $663 | $1,165 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $286 | $390 | $444 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $300 | $538 | $671 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $39 | $436 | $697 |