| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $17 | $170 | $330 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $6 | $156 | $326 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $4 | $137 | $251 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $30 | $147 | $248 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $79 | $84 | $88 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $76 | $163 | $295 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $43 | $116 | $213 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $138 | $220 | $321 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $84 | $211 | $434 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $20 | $148 | $276 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $29 | $353 | $523 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $72 | $201 | $330 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $23 | $366 | $650 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $92 | $309 | $527 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $7 | $73 | $142 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $44 | $83 | $116 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $2 | $11 | $26 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $209 | $304 | $393 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $44 | $161 | $286 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $39 | $156 | $271 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $56 | $124 | $165 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $47 | $215 | $471 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $8 | $16 | $33 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $3 | $12 | $22 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $16 | $58 | $86 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $53 | $89 | $160 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $212 | $530 | $690 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $18 | $74 | $179 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $16 | $56 | $77 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $92 | $393 | $927 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $2,589 | $5,519 | $8,072 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $81 | $162 | $203 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $304 | $1,418 | $3,041 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $74 | $330 | $572 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $270 | $716 | $1,162 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $80 | $690 | $1,241 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $67 | $284 | $517 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $167 | $584 | $972 |
| Septoplasty CPT 30520 • ENT | $67 | $881 | $1,388 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $23 | $261 | $500 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $32 | $249 | $457 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $299 | $498 | $833 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $575 | $707 | $900 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $238 | $702 | $1,320 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $26 | $382 | $651 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $44 | $518 | $1,060 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $278 | $1,039 | $1,695 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $28 | $208 | $427 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $41 | $525 | $1,089 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $30 | $257 | $684 |