| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $46 | $121 | $169 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $56 | $140 | $182 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $48 | $88 | $118 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $63 | $137 | $184 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $33 | $92 | $152 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $35 | $122 | $174 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $91 | $149 | $189 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $75 | $172 | $228 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $123 | $200 | $253 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $106 | $159 | $205 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $128 | $217 | $294 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $147 | $190 | $233 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $155 | $246 | $380 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $82 | $194 | $306 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $73 | $85 | $94 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $37 | $72 | $102 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $4 | $14 | $36 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $167 | $202 | $230 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $45 | $123 | $169 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $57 | $115 | $201 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $28 | $28 | $28 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $49 | $49 | $49 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $30 | $30 | $30 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $9 | $9 | $9 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $40 | $40 | $40 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $82 | $82 | $82 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $112 | $112 | $112 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $26 | $26 | $26 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $13 | $13 | $13 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $160 | $160 | $160 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $1,373 | $1,373 | $1,373 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $43 | $43 | $43 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $3,159 | $3,159 | $3,159 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $291 | $291 | $291 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $977 | $977 | $977 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $444 | $444 | $444 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $202 | $202 | $202 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $340 | $505 | $670 |
| Septoplasty CPT 30520 • ENT | $441 | $697 | $954 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $180 | $194 | $208 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $155 | $236 | $317 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $289 | $342 | $395 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $276 | $351 | $426 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $410 | $517 | $624 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $199 | $254 | $308 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $323 | $409 | $495 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $517 | $653 | $788 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $119 | $206 | $293 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $259 | $356 | $452 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $281 | $376 | $471 |