| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $62 | $87 | $112 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $136 | $186 | $236 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $30 | $43 | $55 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $30 | $53 | $76 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $30 | $43 | $56 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $30 | $49 | $69 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $30 | $63 | $95 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $30 | $71 | $117 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $130 | $136 | $142 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $30 | $56 | $82 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $30 | $89 | $148 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $123 | $123 | $123 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $152 | $309 | $576 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $157 | $157 | $157 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $30 | $60 | $79 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $30 | $54 | $66 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $3 | $13 | $30 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $30 | $87 | $144 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $30 | $68 | $89 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $106 | $205 | $304 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $55 | $84 | $112 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $144 | $144 | $144 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $21 | $21 | $21 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $3 | $5 | $7 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $35 | $54 | $73 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $58 | $58 | $58 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $76 | $76 | $76 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $17 | $17 | $17 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $10 | $43 | $77 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $104 | $516 | $927 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $932 | $932 | $932 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $29 | $150 | $270 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $218 | $1,630 | $3,041 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $190 | $190 | $190 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $774 | $774 | $774 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $412 | $501 | $591 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $172 | $252 | $333 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $30 | $184 | $354 |
| Septoplasty CPT 30520 • ENT | $509 | $644 | $780 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $181 | $181 | $181 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $30 | $84 | $154 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $30 | $256 | $470 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $240 | $240 | $240 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $30 | $263 | $407 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $173 | $320 | $467 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $30 | $159 | $279 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $30 | $237 | $445 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $155 | $256 | $444 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $30 | $214 | $361 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $30 | $145 | $260 |