| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $95 | $166 | $278 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $166 | $166 | $166 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $68 | $79 | $91 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $93 | $93 | $93 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $37 | $37 | $37 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $84 | $113 | $142 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $77 | $77 | $77 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $72 | $107 | $143 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $106 | $188 | $346 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $145 | $206 | $278 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $317 | $317 | $317 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $222 | $222 | $222 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $153 | $270 | $390 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $125 | $125 | $125 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $57 | $77 | $97 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $53 | $74 | $88 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $5 | $6 | $8 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $176 | $176 | $176 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $108 | $130 | $141 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $167 | $167 | $167 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $67 | $67 | $67 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $328 | $328 | $328 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $21 | $21 | $21 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $7 | $7 | $7 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $47 | $47 | $47 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $58 | $58 | $58 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $76 | $76 | $76 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $19 | $19 | $19 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $10 | $10 | $10 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $116 | $116 | $116 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $932 | $932 | $932 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $33 | $33 | $33 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $2,185 | $2,185 | $2,185 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $181 | $181 | $181 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $839 | $839 | $839 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $412 | $412 | $412 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $165 | $165 | $165 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $660 | $660 | $660 |
| Septoplasty CPT 30520 • ENT | $622 | $622 | $622 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $221 | $221 | $221 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $254 | $272 | $290 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $328 | $328 | $328 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $621 | $621 | $621 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $927 | $927 | $927 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $442 | $442 | $442 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $341 | $341 | $341 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $543 | $543 | $543 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $141 | $141 | $141 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $306 | $370 | $434 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $710 | $710 | $710 |