| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $12 | $195 | $330 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $55 | $182 | $326 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $6 | $102 | $251 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $10 | $161 | $311 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $4 | $56 | $108 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $4 | $124 | $295 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $10 | $151 | $322 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $89 | $175 | $277 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $114 | $187 | $306 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $85 | $220 | $355 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $97 | $209 | $322 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $29 | $314 | $599 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $117 | $311 | $650 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $171 | $349 | $527 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $8 | $117 | $264 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $40 | $108 | $198 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $3 | $11 | $26 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $61 | $206 | $393 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $6 | $119 | $286 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $11 | $108 | $227 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $11 | $88 | $165 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $9 | $88 | $166 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $8 | $22 | $50 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $3 | $8 | $17 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $55 | $75 | $98 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $8 | $74 | $160 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $69 | $266 | $518 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $27 | $93 | $178 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $16 | $39 | $76 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $92 | $187 | $309 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $399 | $3,686 | $8,071 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $14 | $99 | $203 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $159 | $2,472 | $6,068 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $184 | $240 | $296 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $68 | $615 | $1,162 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $76 | $359 | $643 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $67 | $167 | $268 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $284 | $850 | $1,417 |
| Septoplasty CPT 30520 • ENT | $406 | $1,215 | $2,024 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $18 | $230 | $442 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $184 | $425 | $666 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $25 | $279 | $532 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $65 | $483 | $900 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $357 | $838 | $1,320 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $30 | $286 | $651 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $282 | $537 | $1,047 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $45 | $632 | $1,667 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $88 | $299 | $510 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $57 | $573 | $1,089 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $42 | $587 | $1,131 |