| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $5 | $60 | $115 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $15 | $79 | $142 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $5 | $52 | $100 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $37 | $75 | $112 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $47 | $47 | $47 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $57 | $57 | $57 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $62 | $62 | $62 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $76 | $76 | $76 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $34 | $34 | $34 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $51 | $51 | $51 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $36 | $109 | $182 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $156 | $156 | $156 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $178 | $202 | $226 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $139 | $139 | $139 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $59 | $59 | $59 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $65 | $65 | $65 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $1 | $1 | $1 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $66 | $80 | $94 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $103 | $106 | $109 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $121 | $125 | $129 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $22 | $67 | $112 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $114 | $132 | $150 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $4 | $6 | $8 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $1 | $2 | $3 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $13 | $43 | $73 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $8 | $30 | $53 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $69 | $69 | $69 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $18 | $98 | $178 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $4 | $6 | $7 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $92 | $394 | $695 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $807 | $2,931 | $5,055 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $27 | $115 | $203 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $304 | $1,292 | $2,280 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $74 | $145 | $216 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $508 | $761 | $1,015 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $800 | $800 | $800 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $195 | $198 | $202 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $87 | $182 | $277 |
| Septoplasty CPT 30520 • ENT | $633 | $634 | $635 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $75 | $75 | $75 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $47 | $110 | $173 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $25 | $132 | $239 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $61 | $235 | $409 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $32 | $170 | $309 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $35 | $105 | $175 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $195 | $195 | $195 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $183 | $183 | $183 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $66 | $66 | $66 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $54 | $205 | $357 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $30 | $30 | $30 |