| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $28 | $169 | $330 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $5 | $177 | $400 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $8 | $63 | $95 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $5 | $145 | $311 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $5 | $132 | $259 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $45 | $110 | $156 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $105 | $199 | $322 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $25 | $206 | $390 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $107 | $218 | $434 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $44 | $200 | $355 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $163 | $216 | $322 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $137 | $368 | $599 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $42 | $215 | $439 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $171 | $290 | $527 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $42 | $92 | $142 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $6 | $70 | $141 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $3 | $9 | $26 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $96 | $191 | $268 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $30 | $140 | $286 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $37 | $144 | $341 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $56 | $93 | $165 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $41 | $179 | $372 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $7 | $22 | $50 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $3 | $8 | $17 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $9 | $50 | $131 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $3 | $48 | $115 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $212 | $307 | $354 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $27 | $67 | $100 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $3 | $14 | $25 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $160 | $328 | $412 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $399 | $2,327 | $3,994 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $81 | $121 | $141 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $159 | $2,472 | $6,068 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $35 | $168 | $296 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $137 | $649 | $1,162 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $189 | $403 | $643 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $79 | $168 | $268 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $378 | $725 | $1,417 |
| Septoplasty CPT 30520 • ENT | $108 | $891 | $2,024 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $19 | $289 | $729 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $134 | $326 | $666 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $112 | $289 | $532 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $183 | $442 | $900 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $36 | $571 | $1,320 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $176 | $334 | $651 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $28 | $373 | $1,047 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $45 | $586 | $1,667 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $88 | $299 | $510 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $269 | $543 | $1,089 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $42 | $587 | $1,131 |