| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $125 | $272 | $418 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $216 | $367 | $518 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $34 | $135 | $337 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $121 | $264 | $407 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $34 | $193 | $353 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $115 | $252 | $389 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $114 | $197 | $280 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $30 | $192 | $354 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $129 | $351 | $573 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $153 | $315 | $478 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $659 | $659 | $659 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $168 | $465 | $762 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $241 | $433 | $817 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $677 | $677 | $677 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $120 | $252 | $384 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $68 | $146 | $224 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $2 | $4 | $7 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $169 | $250 | $331 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $111 | $244 | $377 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $130 | $178 | $274 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $117 | $251 | $386 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $260 | $390 | $520 |
| 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 | $100 | $100 | $100 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $53 | $53 | $53 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $94 | $94 | $94 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $24 | $24 | $24 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $10 | $10 | $10 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $126 | $126 | $126 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $1,099 | $1,099 | $1,099 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $37 | $37 | $37 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $414 | $414 | $414 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $401 | $401 | $401 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $1,047 | $1,047 | $1,047 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $869 | $869 | $869 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $362 | $362 | $362 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $302 | $575 | $1,120 |
| Septoplasty CPT 30520 • ENT | $668 | $1,614 | $2,560 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $824 | $824 | $824 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $206 | $225 | $244 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $274 | $620 | $966 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $1,653 | $1,653 | $1,653 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $1,219 | $1,219 | $1,219 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $172 | $341 | $679 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $231 | $615 | $1,000 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $30 | $727 | $1,423 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $143 | $355 | $717 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $308 | $698 | $1,089 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $322 | $731 | $1,140 |