| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $143 | $180 | $209 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $141 | $193 | $262 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $26 | $86 | $124 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $39 | $90 | $139 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $75 | $94 | $121 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $99 | $141 | $192 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $54 | $134 | $213 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $98 | $172 | $245 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $77 | $83 | $90 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $128 | $282 | $435 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $170 | $239 | $309 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $185 | $264 | $343 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $92 | $236 | $366 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $209 | $264 | $319 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $92 | $130 | $176 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $105 | $165 | $225 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $2 | $6 | $10 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $122 | $181 | $263 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $77 | $158 | $225 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $116 | $157 | $225 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $75 | $101 | $130 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $119 | $165 | $200 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $6 | $6 | $6 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $2 | $2 | $2 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $5 | $50 | $75 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $27 | $55 | $78 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $94 | $401 | $739 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $22 | $108 | $194 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $6 | $46 | $85 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $61 | $396 | $1,004 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $934 | $3,633 | $8,462 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $30 | $166 | $304 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $1,947 | $2,612 | $3,276 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $230 | $335 | $464 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $556 | $702 | $955 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $336 | $404 | $473 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $154 | $225 | $306 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $170 | $1,719 | $3,268 |
| Septoplasty CPT 30520 • ENT | $734 | $2,057 | $3,268 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $134 | $255 | $375 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $234 | $260 | $301 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $289 | $822 | $1,856 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $136 | $2,258 | $5,685 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $414 | $2,178 | $5,685 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $122 | $1,375 | $3,774 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $296 | $2,245 | $5,685 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $255 | $2,271 | $5,685 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $193 | $242 | $291 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $340 | $2,516 | $6,837 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $274 | $1,907 | $3,268 |