| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $67 | $187 | $269 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $59 | $240 | $335 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $30 | $69 | $100 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $30 | $168 | $311 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $30 | $66 | $102 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $30 | $128 | $295 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $30 | $101 | $169 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $30 | $132 | $206 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $225 | $264 | $304 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $30 | $58 | $115 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $30 | $94 | $158 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $223 | $223 | $223 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $30 | $107 | $167 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $122 | $324 | $527 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $30 | $69 | $99 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $30 | $68 | $117 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $2 | $10 | $30 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $30 | $112 | $209 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $30 | $94 | $150 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $87 | $110 | $129 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $94 | $103 | $112 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $157 | $157 | $157 |
| 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 | $13 | $55 | $96 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $29 | $66 | $117 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $28 | $359 | $690 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $12 | $95 | $178 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $3 | $52 | $77 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $61 | $638 | $927 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $315 | $4,193 | $8,071 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $10 | $102 | $270 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $2,280 | $3,796 | $6,068 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $208 | $208 | $208 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $630 | $630 | $630 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $456 | $628 | $800 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $184 | $259 | $333 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $30 | $463 | $1,117 |
| Septoplasty CPT 30520 • ENT | $530 | $846 | $1,162 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $30 | $110 | $190 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $30 | $177 | $352 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $30 | $381 | $658 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $576 | $576 | $576 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $30 | $143 | $256 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $143 | $165 | $175 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $30 | $120 | $211 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $30 | $848 | $1,667 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $30 | $158 | $326 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $30 | $251 | $504 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $30 | $138 | $245 |