| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $30 | $77 | $123 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $94 | $133 | $153 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $21 | $50 | $100 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $30 | $75 | $119 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $30 | $47 | $65 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $30 | $51 | $71 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $30 | $77 | $124 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $30 | $51 | $94 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $105 | $105 | $105 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $30 | $58 | $86 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $30 | $99 | $193 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $30 | $86 | $141 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $30 | $140 | $237 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $125 | $125 | $125 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $30 | $49 | $68 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $30 | $31 | $33 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $1 | $16 | $30 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $30 | $52 | $97 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $30 | $69 | $109 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $81 | $112 | $129 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $71 | $98 | $112 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $100 | $126 | $152 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $3 | $6 | $8 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $1 | $3 | $3 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $31 | $53 | $73 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $23 | $38 | $53 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $31 | $275 | $518 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $8 | $93 | $178 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $3 | $29 | $77 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $41 | $353 | $927 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $350 | $578 | $807 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $11 | $184 | $270 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $139 | $1,161 | $3,041 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $139 | $253 | $368 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $420 | $420 | $420 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $228 | $609 | $800 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $112 | $260 | $333 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $30 | $165 | $291 |
| Septoplasty CPT 30520 • ENT | $399 | $532 | $665 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $134 | $174 | $215 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $30 | $111 | $183 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $30 | $126 | $250 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $151 | $291 | $431 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $30 | $183 | $317 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $112 | $154 | $175 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $30 | $97 | $165 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $30 | $211 | $369 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $30 | $48 | $84 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $30 | $164 | $284 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $30 | $108 | $187 |