| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $123 | $150 | $195 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $144 | $149 | $153 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $30 | $129 | $257 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $30 | $153 | $310 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $30 | $112 | $269 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $30 | $163 | $296 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $30 | $145 | $324 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $30 | $163 | $269 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $139 | $287 | $436 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $30 | $70 | $110 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $30 | $142 | $203 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $241 | $241 | $241 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $30 | $148 | $237 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $516 | $516 | $516 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $30 | $66 | $138 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $30 | $70 | $111 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $6 | $15 | $30 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $30 | $141 | $252 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $30 | $110 | $185 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $128 | $132 | $138 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $74 | $99 | $112 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $152 | $293 | $435 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $8 | $14 | $19 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $2 | $3 | $3 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $13 | $63 | $96 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $51 | $87 | $117 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $66 | $378 | $690 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $17 | $24 | $30 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $11 | $54 | $77 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $88 | $570 | $927 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $985 | $1,210 | $1,435 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $26 | $189 | $270 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $304 | $1,231 | $3,041 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $280 | $346 | $411 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $786 | $786 | $786 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $608 | $704 | $800 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $254 | $319 | $372 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $30 | $477 | $1,117 |
| Septoplasty CPT 30520 • ENT | $530 | $1,112 | $2,141 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $146 | $146 | $146 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $30 | $197 | $352 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $30 | $249 | $439 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $298 | $364 | $431 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $30 | $455 | $1,019 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $175 | $189 | $216 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $30 | $136 | $347 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $30 | $290 | $550 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $30 | $251 | $618 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $30 | $439 | $938 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $30 | $219 | $329 |