| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $28 | $89 | $150 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $25 | $104 | $184 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $5 | $42 | $80 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $4 | $75 | $145 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $95 | $95 | $95 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $18 | $35 | $53 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $20 | $20 | $20 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $12 | $12 | $12 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $67 | $67 | $67 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $121 | $121 | $121 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $40 | $137 | $234 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $80 | $80 | $80 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $28 | $159 | $289 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $24 | $24 | $24 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $40 | $63 | $86 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $5 | $5 | $5 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $2 | $2 | $2 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $40 | $58 | $76 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $77 | $104 | $131 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $94 | $124 | $154 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $29 | $87 | $145 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $149 | $176 | $203 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $6 | $6 | $6 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $2 | $2 | $3 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $12 | $38 | $64 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $6 | $29 | $52 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $485 | $550 | $615 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $126 | $146 | $167 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $7 | $38 | $68 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $86 | $456 | $826 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $7,571 | $7,571 | $7,572 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $181 | $185 | $190 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $2,140 | $2,496 | $2,852 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $28 | $107 | $185 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $269 | $399 | $528 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $60 | $60 | $60 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $86 | $127 | $168 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $255 | $297 | $339 |
| Septoplasty CPT 30520 • ENT | $580 | $676 | $773 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $21 | $97 | $174 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $22 | $123 | $224 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $182 | $238 | $293 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $280 | $391 | $503 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $56 | $213 | $371 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $40 | $102 | $165 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $182 | $243 | $304 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $65 | $250 | $434 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $12 | $12 | $12 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $195 | $273 | $351 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $37 | $37 | $37 |