| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $46 | $109 | $143 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $55 | $137 | $173 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $30 | $65 | $100 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $30 | $83 | $119 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $30 | $54 | $104 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $30 | $73 | $113 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $30 | $85 | $124 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $30 | $102 | $152 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $73 | $141 | $167 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $30 | $107 | $145 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $30 | $137 | $193 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $182 | $201 | $222 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $30 | $183 | $237 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $102 | $159 | $198 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $30 | $63 | $96 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $30 | $57 | $69 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $2 | $10 | $30 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $30 | $133 | $226 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $30 | $70 | $105 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $106 | $119 | $129 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $46 | $87 | $112 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $59 | $184 | $374 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $6 | $11 | $21 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $3 | $4 | $7 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $13 | $44 | $73 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $12 | $33 | $53 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $76 | $345 | $690 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $13 | $82 | $178 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $7 | $36 | $77 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $60 | $513 | $927 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $932 | $5,691 | $8,071 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $27 | $127 | $270 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $218 | $1,952 | $3,041 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $190 | $312 | $368 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $774 | $945 | $1,015 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $412 | $702 | $800 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $172 | $292 | $333 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $30 | $259 | $354 |
| Septoplasty CPT 30520 • ENT | $483 | $580 | $665 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $142 | $172 | $215 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $30 | $153 | $200 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $30 | $249 | $366 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $240 | $360 | $431 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $30 | $303 | $501 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $173 | $189 | $244 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $30 | $245 | $396 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $30 | $369 | $632 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $30 | $131 | $191 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $30 | $235 | $329 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $30 | $248 | $355 |