| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $233 | $463 | $670 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $117 | $378 | $670 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $30 | $190 | $650 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $30 | $299 | $650 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $30 | $184 | $650 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $30 | $320 | $650 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $30 | $299 | $475 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $30 | $310 | $475 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $311 | $414 | $475 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $30 | $347 | $650 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $30 | $360 | $475 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $429 | $459 | $475 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $457 | $469 | $475 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $375 | $533 | $650 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $30 | $245 | $475 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $30 | $172 | $475 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $11 | $144 | $475 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $30 | $379 | $650 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $30 | $249 | $475 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $60 | $346 | $475 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $112 | $120 | $131 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $291 | $414 | $475 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $8 | $16 | $32 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $3 | $5 | $11 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $13 | $55 | $73 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $21 | $42 | $53 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $134 | $505 | $690 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $30 | $129 | $178 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $7 | $44 | $77 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $181 | $741 | $927 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $1,642 | $5,928 | $8,071 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $52 | $215 | $270 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $577 | $2,235 | $3,041 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $334 | $357 | $368 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $1,015 | $1,163 | $1,310 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $725 | $781 | $800 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $302 | $325 | $333 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $30 | $550 | $834 |
| Septoplasty CPT 30520 • ENT | $650 | $828 | $1,187 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $150 | $335 | $475 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $30 | $357 | $650 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $30 | $481 | $650 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $530 | $625 | $670 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $30 | $610 | $942 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $30 | $353 | $670 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $30 | $523 | $670 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $30 | $596 | $980 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $30 | $395 | $650 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $30 | $513 | $670 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $30 | $552 | $942 |