| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $62 | $92 | $123 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $75 | $75 | $75 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $30 | $76 | $100 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $91 | $91 | $91 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $39 | $72 | $104 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $30 | $37 | $44 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $119 | $121 | $124 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $99 | $126 | $152 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $109 | $138 | $167 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $30 | $81 | $132 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $111 | $111 | $111 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $214 | $214 | $214 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $155 | $196 | $238 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $189 | $189 | $189 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $78 | $88 | $98 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $30 | $57 | $76 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $2 | $13 | $30 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $30 | $103 | $176 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $62 | $93 | $109 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $80 | $112 | $129 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $59 | $59 | $59 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $161 | $161 | $161 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $8 | $8 | $8 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $3 | $3 | $3 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $13 | $53 | $73 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $53 | $53 | $53 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $690 | $690 | $690 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $178 | $178 | $178 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $76 | $76 | $76 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $927 | $927 | $927 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $8,071 | $8,071 | $8,071 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $27 | $149 | $270 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $2,280 | $2,787 | $3,041 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $800 | $800 | $800 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $333 | $333 | $333 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $291 | $338 | $431 |
| Septoplasty CPT 30520 • ENT | $599 | $632 | $665 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $30 | $128 | $225 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $82 | $132 | $183 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $197 | $197 | $197 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $301 | $301 | $301 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $444 | $444 | $444 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $175 | $190 | $218 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $351 | $351 | $351 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $560 | $560 | $560 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $188 | $188 | $188 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $306 | $306 | $306 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $321 | $321 | $321 |
| Tonsillectomy primary under age 12 CPT 42826 • ENT | $265 | $265 | $265 |
| Adenoidectomy primary under age 12 CPT 42830 • ENT | $216 | $216 | $216 |