| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $215 | $272 | $330 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $127 | $206 | $326 |
| 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 | $83 | $171 | $259 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $97 | $182 | $295 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $80 | $168 | $322 |
| 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 | $225 | $329 | $434 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $114 | $223 | $333 |
| 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 | $400 | $400 | $400 |
| 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 | $527 | $527 | $527 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $78 | $110 | $142 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $44 | $99 | $198 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $1 | $9 | $26 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $30 | $190 | $393 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $94 | $159 | $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 | $372 | $372 | $372 |
| 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 | $47 | $66 | $98 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $53 | $106 | $160 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $212 | $365 | $518 |
| 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 | $500 | $927 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $2,589 | $5,330 | $8,071 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $19 | $121 | $202 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $1,587 | $3,565 | $6,068 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $296 | $296 | $296 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $1,162 | $1,162 | $1,162 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $378 | $511 | $643 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $158 | $174 | $190 |
| 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 | $729 | $729 | $729 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $178 | $318 | $458 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $224 | $528 | $833 |
| 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 | $688 | $925 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $174 | $316 | $458 |
| 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 |