| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $42 | $87 | $119 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $25 | $96 | $145 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $6 | $107 | $237 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $19 | $135 | $289 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $40 | $59 | $97 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $39 | $120 | $275 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $71 | $185 | $299 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $40 | $145 | $250 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $14 | $171 | $405 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $40 | $161 | $333 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $20 | $215 | $470 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $40 | $294 | $548 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $40 | $211 | $393 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $32 | $168 | $304 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $42 | $74 | $135 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $6 | $60 | $129 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $0 | $3 | $5 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $40 | $166 | $377 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $40 | $131 | $265 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $40 | $114 | $198 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $19 | $126 | $266 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $104 | $207 | $380 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $5 | $6 | $7 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $2 | $3 | $3 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $41 | $45 | $52 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $28 | $30 | $32 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $41 | $166 | $408 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $12 | $71 | $115 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $4 | $16 | $38 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $47 | $154 | $353 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $573 | $2,883 | $4,614 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $19 | $115 | $163 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $183 | $998 | $1,438 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $27 | $139 | $210 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $141 | $482 | $823 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $195 | $347 | $456 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $24 | $125 | $190 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $45 | $483 | $725 |
| Septoplasty CPT 30520 • ENT | $100 | $1,103 | $1,658 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $108 | $312 | $515 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $33 | $316 | $458 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $32 | $420 | $623 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $40 | $570 | $1,075 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $27 | $537 | $793 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $113 | $235 | $440 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $167 | $408 | $648 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $48 | $486 | $925 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $15 | $236 | $458 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $36 | $482 | $709 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $174 | $452 | $730 |