| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $39 | $69 | $100 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $47 | $47 | $47 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $45 | $45 | $45 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $63 | $63 | $63 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $47 | $47 | $47 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $57 | $57 | $57 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $51 | $51 | $51 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $95 | $173 | $250 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $106 | $123 | $139 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $86 | $86 | $86 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $119 | $119 | $119 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $147 | $147 | $147 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $162 | $162 | $162 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $82 | $82 | $82 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $67 | $67 | $67 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $37 | $74 | $111 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $5 | $7 | $9 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $93 | $93 | $93 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $46 | $115 | $185 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $87 | $87 | $87 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $51 | $51 | $51 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $133 | $133 | $133 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $8 | $16 | $23 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $3 | $5 | $6 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $49 | $82 | $102 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $61 | $90 | $117 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $76 | $99 | $122 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $17 | $24 | $30 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $10 | $12 | $15 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $105 | $137 | $169 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $932 | $1,183 | $1,435 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $34 | $40 | $47 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $533 | $1,359 | $2,185 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $194 | $302 | $411 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $593 | $917 | $1,241 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $359 | $626 | $892 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $167 | $269 | $372 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $315 | $716 | $1,117 |
| Septoplasty CPT 30520 • ENT | $447 | $489 | $530 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $160 | $160 | $160 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $138 | $245 | $352 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $243 | $341 | $439 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $219 | $219 | $219 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $323 | $323 | $323 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $158 | $158 | $158 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $255 | $255 | $255 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $408 | $408 | $408 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $97 | $212 | $326 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $211 | $357 | $504 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $220 | $220 | $220 |