| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $62 | $90 | $117 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $141 | $141 | $141 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $232 | $232 | $232 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $283 | $283 | $283 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $245 | $245 | $245 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $112 | $112 | $112 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $192 | $192 | $192 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $65 | $211 | $357 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $175 | $285 | $396 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $242 | $242 | $242 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $286 | $286 | $286 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $351 | $351 | $351 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $152 | $364 | $577 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $297 | $297 | $297 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $70 | $101 | $132 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $56 | $104 | $152 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $3 | $8 | $14 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $368 | $368 | $368 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $85 | $121 | $157 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $305 | $305 | $305 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $207 | $207 | $207 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $296 | $296 | $296 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $5 | $5 | $5 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $2 | $2 | $2 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $52 | $52 | $52 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $5 | $5 | $5 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $49 | $49 | $49 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $12 | $12 | $12 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $5 | $5 | $5 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $63 | $63 | $63 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $573 | $573 | $573 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $19 | $19 | $19 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $1,438 | $1,438 | $1,438 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $210 | $210 | $210 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $823 | $823 | $823 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $456 | $456 | $456 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $190 | $190 | $190 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $167 | $416 | $664 |
| Septoplasty CPT 30520 • ENT | $780 | $1,148 | $1,517 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $336 | $336 | $336 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $69 | $258 | $447 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $470 | $531 | $593 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $985 | $985 | $985 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $407 | $591 | $775 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $430 | $430 | $430 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $167 | $400 | $633 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $904 | $904 | $904 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $168 | $308 | $447 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $361 | $522 | $684 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $713 | $713 | $713 |