| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $215 | $273 | $330 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $127 | $147 | $166 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $67 | $121 | $251 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $102 | $137 | $163 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $45 | $129 | $259 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $96 | $161 | $295 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $105 | $162 | $213 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $127 | $240 | $390 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $99 | $173 | $306 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $30 | $166 | $355 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $164 | $335 | $506 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $599 | $599 | $599 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $212 | $380 | $650 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $109 | $318 | $527 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $42 | $87 | $142 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $44 | $81 | $141 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $1 | $3 | $7 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $94 | $206 | $393 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $94 | $160 | $286 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $87 | $180 | $341 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $56 | $111 | $165 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $166 | $166 | $166 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $8 | $29 | $50 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $3 | $8 | $17 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $9 | $62 | $131 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $53 | $106 | $160 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $212 | $451 | $690 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $27 | $102 | $178 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $16 | $42 | $76 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $160 | $328 | $412 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $2,589 | $5,330 | $8,071 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $81 | $164 | $270 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $1,586 | $3,080 | $6,068 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $296 | $296 | $296 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $683 | $922 | $1,162 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $378 | $607 | $799 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $158 | $213 | $268 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $379 | $898 | $1,417 |
| Septoplasty CPT 30520 • ENT | $2,024 | $2,024 | $2,024 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $194 | $462 | $729 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $178 | $422 | $666 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $224 | $378 | $532 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $900 | $900 | $900 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $357 | $838 | $1,320 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $176 | $334 | $651 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $283 | $665 | $1,047 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $450 | $1,058 | $1,667 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $173 | $351 | $706 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $270 | $679 | $1,089 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $282 | $706 | $1,131 |