| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $10 | $56 | $101 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $48 | $85 | $122 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $8 | $42 | $77 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $19 | $56 | $93 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $29 | $30 | $32 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $32 | $32 | $33 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $19 | $19 | $19 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $33 | $33 | $33 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $128 | $128 | $128 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $33 | $69 | $105 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $15 | $81 | $148 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $84 | $84 | $84 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $29 | $109 | $190 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $19 | $19 | $19 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $28 | $28 | $28 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $8 | $8 | $8 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $0 | $0 | $0 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $17 | $17 | $17 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $5 | $46 | $87 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $66 | $84 | $102 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $75 | $75 | $75 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $32 | $95 | $157 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $5 | $5 | $6 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $2 | $2 | $2 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $9 | $28 | $47 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $47 | $55 | $63 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $739 | $739 | $739 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $17 | $92 | $167 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $73 | $73 | $74 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $99 | $423 | $746 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $903 | $4,967 | $9,031 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $243 | $243 | $244 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $318 | $1,349 | $2,381 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $49 | $146 | $243 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $60 | $60 | $60 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $59 | $59 | $59 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $161 | $161 | $161 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $355 | $355 | $355 |
| Septoplasty CPT 30520 • ENT | $33 | $262 | $491 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $11 | $11 | $11 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $26 | $99 | $172 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $19 | $112 | $205 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $31 | $120 | $208 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $30 | $167 | $304 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $30 | $91 | $152 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $242 | $242 | $243 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $77 | $230 | $383 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $69 | $133 | $197 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $145 | $217 | $289 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $30 | $30 | $30 |