| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $123 | $188 | $254 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $308 | $308 | $308 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $25 | $75 | $100 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $246 | $246 | $246 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $56 | $56 | $56 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $37 | $75 | $113 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $62 | $93 | $124 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $152 | $231 | $310 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $131 | $149 | $167 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $211 | $211 | $211 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $92 | $92 | $92 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $30 | $248 | $465 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $238 | $370 | $502 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $154 | $154 | $154 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $30 | $63 | $80 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $65 | $99 | $132 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $2 | $15 | $30 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $30 | $175 | $320 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $82 | $100 | $109 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $97 | $118 | $129 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $226 | $226 | $226 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $133 | $133 | $133 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $8 | $11 | $18 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $3 | $4 | $6 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $52 | $63 | $73 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $42 | $49 | $53 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $77 | $486 | $690 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $12 | $123 | $178 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $5 | $52 | $76 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $63 | $639 | $927 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $573 | $5,572 | $8,071 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $19 | $164 | $270 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $216 | $2,144 | $3,041 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $210 | $210 | $210 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $823 | $823 | $823 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $456 | $628 | $800 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $190 | $262 | $333 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $291 | $387 | $578 |
| Septoplasty CPT 30520 • ENT | $581 | $623 | $665 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $220 | $220 | $220 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $183 | $186 | $189 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $341 | $341 | $341 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $505 | $505 | $505 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $674 | $674 | $674 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $175 | $242 | $374 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $30 | $290 | $551 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $580 | $580 | $580 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $188 | $289 | $389 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $595 | $595 | $595 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $333 | $333 | $333 |