| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $101 | $177 | $254 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $122 | $215 | $308 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $77 | $118 | $202 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $93 | $169 | $246 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $213 | $213 | $213 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $32 | $133 | $234 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $167 | $167 | $167 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $310 | $310 | $310 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $235 | $235 | $235 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $283 | $283 | $283 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $148 | $274 | $400 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $305 | $305 | $305 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $190 | $294 | $502 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $411 | $411 | $411 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $115 | $115 | $115 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $132 | $132 | $132 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $12 | $12 | $12 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $320 | $320 | $320 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $87 | $156 | $225 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $102 | $124 | $168 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $75 | $150 | $226 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $135 | $146 | $157 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $5 | $5 | $5 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $2 | $5 | $6 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $9 | $32 | $47 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $38 | $50 | $63 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $49 | $394 | $739 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $12 | $90 | $167 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $5 | $52 | $98 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $63 | $529 | $995 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $573 | $4,802 | $9,031 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $19 | $172 | $325 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $216 | $1,924 | $3,176 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $210 | $226 | $243 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $823 | $823 | $823 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $391 | $423 | $456 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $161 | $171 | $190 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $355 | $429 | $578 |
| Septoplasty CPT 30520 • ENT | $491 | $905 | $1,319 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $438 | $438 | $438 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $132 | $152 | $172 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $205 | $266 | $328 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $208 | $532 | $857 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $304 | $489 | $674 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $152 | $226 | $374 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $551 | $551 | $551 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $32 | $409 | $786 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $198 | $293 | $389 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $289 | $442 | $595 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $620 | $620 | $620 |