| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $117 | $242 | $367 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $153 | $304 | $456 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $100 | $171 | $296 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $119 | $238 | $356 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $105 | $206 | $308 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $83 | $179 | $340 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $125 | $251 | $377 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $153 | $305 | $458 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $334 | $334 | $334 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $101 | $221 | $422 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $183 | $242 | $351 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $222 | $445 | $668 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $228 | $454 | $714 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $116 | $240 | $364 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $79 | $207 | $336 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $65 | $132 | $198 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $0 | $3 | $6 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $94 | $249 | $490 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $110 | $223 | $336 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $123 | $247 | $391 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $112 | $172 | $291 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $375 | $375 | $375 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $8 | $13 | $19 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $2 | $4 | $8 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $18 | $123 | $238 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $53 | $90 | $126 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $690 | $1,206 | $1,723 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $178 | $340 | $502 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $76 | $99 | $144 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $927 | $1,364 | $2,238 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $1,687 | $5,466 | $9,245 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $270 | $379 | $597 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $735 | $2,464 | $3,617 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $268 | $722 | $1,177 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $657 | $761 | $866 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $800 | $1,299 | $1,799 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $240 | $432 | $813 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $276 | $475 | $859 |
| Septoplasty CPT 30520 • ENT | $1,968 | $1,968 | $1,968 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $150 | $398 | $646 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $184 | $367 | $551 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $238 | $313 | $452 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $408 | $838 | $1,268 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $296 | $506 | $904 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $341 | $396 | $505 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $259 | $501 | $744 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $370 | $765 | $1,057 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $176 | $309 | $564 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $270 | $465 | $841 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $282 | $486 | $879 |