| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $50 | $167 | $286 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $62 | $171 | $231 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $20 | $92 | $148 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $51 | $143 | $278 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $39 | $95 | $155 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $44 | $110 | $171 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $57 | $159 | $292 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $99 | $178 | $323 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $145 | $222 | $392 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $125 | $173 | $239 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $72 | $219 | $391 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $142 | $285 | $466 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $151 | $270 | $368 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $171 | $266 | $452 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $59 | $107 | $171 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $53 | $76 | $103 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $1 | $14 | $40 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $37 | $158 | $251 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $79 | $150 | $258 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $80 | $153 | $295 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $50 | $106 | $155 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $57 | $153 | $235 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $5 | $21 | $41 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $2 | $6 | $11 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $6 | $49 | $85 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $5 | $61 | $123 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $56 | $389 | $1,104 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $16 | $56 | $184 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $11 | $73 | $177 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $140 | $480 | $1,005 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $75 | $5,585 | $18,881 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $33 | $246 | $586 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $282 | $2,544 | $4,426 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $198 | $241 | $329 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $549 | $817 | $989 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $330 | $531 | $800 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $191 | $392 | $645 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $263 | $471 | $725 |
| Septoplasty CPT 30520 • ENT | $537 | $1,017 | $1,658 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $164 | $315 | $536 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $71 | $265 | $458 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $197 | $405 | $623 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $285 | $570 | $1,075 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $217 | $510 | $790 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $168 | $286 | $437 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $273 | $421 | $646 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $389 | $637 | $921 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $114 | $254 | $469 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $286 | $465 | $709 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $208 | $445 | $740 |