| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $54 | $90 | $126 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $47 | $101 | $155 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $38 | $80 | $101 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $53 | $90 | $126 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $41 | $59 | $78 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $86 | $101 | $116 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $93 | $110 | $127 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $157 | $157 | $157 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $118 | $146 | $175 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $104 | $104 | $104 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $203 | $203 | $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 | $127 | $206 | $245 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $152 | $152 | $152 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $105 | $110 | $115 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $55 | $56 | $56 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $4 | $5 | $7 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $118 | $118 | $118 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $74 | $93 | $111 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $63 | $63 | $63 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $74 | $74 | $74 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $104 | $104 | $104 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $19 | $19 | $19 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $7 | $7 | $7 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $37 | $37 | $37 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $61 | $61 | $61 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $62 | $62 | $62 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $15 | $15 | $15 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $7 | $7 | $7 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $109 | $109 | $109 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $985 | $985 | $985 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $31 | $31 | $31 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $2,310 | $2,310 | $2,310 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $201 | $201 | $201 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $786 | $786 | $786 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $397 | $397 | $397 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $181 | $181 | $181 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $144 | $214 | $309 |
| Septoplasty CPT 30520 • ENT | $496 | $602 | $707 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $146 | $146 | $146 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $142 | $166 | $191 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $175 | $220 | $265 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $298 | $377 | $457 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $350 | $393 | $436 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $192 | $200 | $216 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $285 | $316 | $347 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $55 | $303 | $550 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $144 | $165 | $202 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $228 | $272 | $315 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $238 | $283 | $328 |