| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $16 | $107 | $169 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $26 | $185 | $400 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $42 | $72 | $95 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $7 | $146 | $311 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $8 | $103 | $259 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $42 | $141 | $295 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $7 | $134 | $322 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $42 | $148 | $277 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $14 | $151 | $434 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $23 | $114 | $276 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $42 | $237 | $506 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $42 | $246 | $599 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $212 | $338 | $650 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $42 | $204 | $527 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $12 | $65 | $142 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $6 | $83 | $198 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $0 | $19 | $42 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $19 | $166 | $393 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $6 | $108 | $184 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $15 | $110 | $227 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $32 | $87 | $165 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $6 | $171 | $372 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $5 | $20 | $50 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $2 | $7 | $17 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $24 | $45 | $64 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $47 | $90 | $160 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $212 | $573 | $754 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $27 | $132 | $184 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $16 | $77 | $108 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $100 | $120 | $160 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $905 | $4,182 | $9,052 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $81 | $179 | $228 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $316 | $2,920 | $6,068 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $198 | $231 | $296 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $55 | $608 | $1,162 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $397 | $520 | $643 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $16 | $148 | $268 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $466 | $783 | $1,417 |
| Septoplasty CPT 30520 • ENT | $99 | $927 | $2,024 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $24 | $265 | $729 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $51 | $162 | $222 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $128 | $311 | $532 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $58 | $415 | $900 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $42 | $595 | $1,320 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $157 | $339 | $651 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $42 | $475 | $1,047 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $42 | $605 | $1,667 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $44 | $375 | $706 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $169 | $531 | $1,089 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $42 | $408 | $1,131 |