| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $104 | $191 | $278 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $337 | $337 | $337 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $100 | $109 | $127 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $161 | $161 | $161 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $37 | $78 | $118 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $153 | $153 | $153 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $80 | $146 | $211 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $66 | $162 | $258 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $73 | $209 | $346 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $118 | $198 | $278 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $317 | $317 | $317 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $30 | $197 | $365 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $103 | $244 | $390 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $122 | $226 | $330 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $78 | $112 | $164 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $49 | $93 | $138 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $2 | $13 | $32 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $163 | $301 | $439 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $94 | $115 | $144 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $95 | $130 | $167 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $110 | $110 | $110 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $99 | $213 | $328 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $8 | $15 | $21 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $3 | $5 | $7 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $48 | $65 | $73 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $53 | $61 | $69 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $86 | $388 | $690 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $19 | $99 | $178 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $11 | $40 | $76 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $92 | $104 | $116 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $1,052 | $4,561 | $8,071 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $33 | $152 | $270 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $304 | $1,971 | $3,041 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $181 | $181 | $181 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $839 | $897 | $955 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $392 | $664 | $800 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $165 | $249 | $333 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $291 | $476 | $660 |
| Septoplasty CPT 30520 • ENT | $961 | $961 | $961 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $298 | $298 | $298 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $254 | $254 | $254 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $512 | $512 | $512 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $621 | $621 | $621 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $927 | $927 | $927 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $175 | $264 | $442 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $30 | $379 | $729 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $1,177 | $1,177 | $1,177 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $188 | $295 | $401 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $655 | $655 | $655 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $710 | $710 | $710 |