| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $35 | $119 | $203 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $16 | $66 | $117 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $7 | $47 | $102 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $17 | $29 | $41 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $101 | $136 | $170 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $44 | $67 | $89 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $99 | $104 | $110 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $16 | $75 | $133 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $89 | $89 | $90 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $22 | $60 | $97 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $94 | $207 | $320 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $176 | $176 | $177 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $126 | $171 | $215 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $105 | $155 | $205 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $6 | $44 | $85 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $9 | $40 | $57 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $2 | $17 | $44 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $78 | $167 | $255 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $45 | $66 | $86 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $65 | $90 | $114 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $89 | $106 | $124 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $24 | $43 | $62 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $5 | $6 | $7 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $1 | $2 | $3 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $9 | $30 | $46 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $26 | $31 | $38 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $37 | $121 | $280 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $12 | $49 | $124 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $5 | $22 | $34 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $61 | $304 | $481 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $525 | $2,138 | $5,353 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $11 | $116 | $192 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $924 | $1,429 | $2,113 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $139 | $177 | $215 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $66 | $296 | $525 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $32 | $158 | $285 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $88 | $128 | $169 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $96 | $278 | $461 |
| Septoplasty CPT 30520 • ENT | $609 | $707 | $805 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $26 | $96 | $167 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $14 | $37 | $60 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $26 | $124 | $221 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $230 | $303 | $375 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $57 | $294 | $531 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $42 | $132 | $212 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $31 | $141 | $251 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $333 | $370 | $406 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $215 | $263 | $311 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $157 | $314 | $471 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $44 | $268 | $491 |