| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $29 | $184 | $418 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $47 | $122 | $189 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $21 | $148 | $337 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $21 | $176 | $407 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $13 | $70 | $127 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $38 | $213 | $389 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $10 | $218 | $426 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $91 | $306 | $521 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $29 | $301 | $573 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $120 | $299 | $478 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $25 | $282 | $659 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $12 | $387 | $762 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $67 | $363 | $817 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $127 | $402 | $677 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $114 | $147 | $181 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $56 | $119 | $182 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $2 | $12 | $22 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $17 | $174 | $331 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $14 | $162 | $377 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $48 | $144 | $274 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $22 | $171 | $386 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $15 | $226 | $520 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $7 | $8 | $8 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $3 | $3 | $3 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $11 | $32 | $75 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $10 | $36 | $49 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $94 | $382 | $601 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $24 | $113 | $158 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $6 | $8 | $10 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $82 | $273 | $612 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $1,099 | $4,950 | $6,876 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $37 | $136 | $186 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $414 | $1,469 | $1,997 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $54 | $241 | $401 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $482 | $764 | $1,047 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $62 | $465 | $869 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $94 | $214 | $362 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $123 | $511 | $1,120 |
| Septoplasty CPT 30520 • ENT | $502 | $1,244 | $2,560 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $75 | $289 | $575 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $32 | $308 | $708 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $16 | $411 | $966 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $216 | $767 | $1,653 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $63 | $533 | $1,219 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $177 | $344 | $679 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $39 | $519 | $1,000 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $74 | $749 | $1,423 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $38 | $315 | $717 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $216 | $531 | $1,089 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $60 | $600 | $1,140 |