| Tangential biopsy of skin single lesion CPT 11102 • Dermatology | $37 | $268 | $623 |
| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $111 | $452 | $623 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $158 | $472 | $623 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $30 | $67 | $135 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $30 | $58 | $100 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $30 | $47 | $65 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $30 | $75 | $116 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $129 | $429 | $623 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $42 | $354 | $623 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $73 | $337 | $623 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $257 | $630 | $755 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $176 | $446 | $623 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $207 | $437 | $623 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $199 | $420 | $623 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $167 | $433 | $755 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $193 | $516 | $623 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $57 | $405 | $623 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $6 | $376 | $623 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $125 | $434 | $623 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $61 | $360 | $623 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $104 | $308 | $623 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $85 | $99 | $112 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $91 | $446 | $623 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $23 | $23 | $23 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $3 | $6 | $8 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $35 | $54 | $73 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $50 | $50 | $50 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $76 | $76 | $76 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $13 | $15 | $17 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $10 | $43 | $77 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $60 | $364 | $927 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $1,010 | $1,010 | $1,010 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $32 | $151 | $270 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $2,185 | $2,613 | $3,041 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $206 | $206 | $206 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $774 | $774 | $774 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $383 | $591 | $800 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $186 | $260 | $333 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $216 | $812 | $1,974 |
| Septoplasty CPT 30520 • ENT | $537 | $1,142 | $1,974 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $216 | $487 | $623 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $148 | $492 | $755 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $246 | $711 | $1,121 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $373 | $1,603 | $3,434 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $548 | $1,388 | $3,434 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $218 | $885 | $2,279 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $310 | $994 | $2,119 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $494 | $1,431 | $3,434 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $144 | $503 | $623 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $307 | $1,395 | $4,129 |