| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $56 | $221 | $795 |
| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $79 | $380 | $795 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $48 | $474 | $796 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $42 | $392 | $796 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $42 | $384 | $796 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $67 | $365 | $796 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $39 | $356 | $796 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $73 | $414 | $796 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $67 | $374 | $796 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $100 | $295 | $795 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $91 | $370 | $796 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $169 | $511 | $796 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $94 | $386 | $795 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $79 | $385 | $795 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $110 | $283 | $795 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $79 | $370 | $796 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $35 | $425 | $796 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $2 | $279 | $796 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $79 | $326 | $796 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $42 | $373 | $796 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $72 | $345 | $795 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $87 | $231 | $424 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $45 | $405 | $795 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $5 | $7 | $11 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $2 | $3 | $6 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $6 | $38 | $67 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $4 | $18 | $35 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $45 | $137 | $492 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $13 | $87 | $165 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $6 | $14 | $43 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $61 | $554 | $879 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $75 | $2,578 | $5,165 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $22 | $124 | $199 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $208 | $1,699 | $2,867 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $212 | $263 | $409 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $593 | $673 | $742 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $330 | $392 | $508 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $154 | $186 | $221 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $178 | $653 | $1,100 |
| Septoplasty CPT 30520 • ENT | $430 | $834 | $1,306 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $129 | $485 | $795 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $79 | $485 | $796 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $228 | $579 | $796 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $276 | $802 | $1,470 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $203 | $781 | $1,500 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $113 | $626 | $1,100 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $226 | $797 | $1,470 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $322 | $876 | $1,500 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $79 | $370 | $795 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $254 | $697 | $1,100 |