| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $109 | $218 | $326 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $135 | $141 | $147 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $89 | $89 | $89 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $106 | $212 | $317 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $30 | $64 | $99 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $30 | $166 | $303 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $218 | $218 | $218 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $276 | $276 | $276 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $446 | $446 | $446 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $373 | $373 | $373 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $171 | $244 | $317 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $30 | $312 | $594 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $42 | $297 | $637 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $30 | $279 | $528 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $141 | $150 | $159 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $174 | $174 | $174 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $5 | $18 | $30 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $163 | $301 | $438 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $167 | $209 | $294 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $114 | $191 | $344 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $110 | $205 | $301 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $149 | $158 | $166 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $3 | $4 | $5 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $1 | $2 | $2 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $7 | $43 | $73 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $4 | $22 | $40 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $38 | $364 | $690 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $10 | $70 | $130 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $4 | $40 | $76 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $50 | $59 | $68 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $440 | $3,154 | $5,868 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $15 | $142 | $270 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $304 | $1,202 | $2,197 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $160 | $183 | $206 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $419 | $443 | $467 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $348 | $574 | $800 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $145 | $167 | $178 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $285 | $449 | $776 |
| Septoplasty CPT 30520 • ENT | $652 | $1,213 | $1,774 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $399 | $399 | $399 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $180 | $335 | $490 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $245 | $331 | $417 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $423 | $784 | $1,145 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $310 | $577 | $845 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $172 | $271 | $470 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $693 | $693 | $693 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $30 | $508 | $986 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $25 | $190 | $356 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $270 | $517 | $765 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $801 | $801 | $801 |