| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $4 | $168 | $330 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $99 | $275 | $400 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $6 | $102 | $251 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $103 | $170 | $311 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $45 | $152 | $259 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $10 | $140 | $295 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $7 | $142 | $322 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $46 | $214 | $390 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $15 | $224 | $434 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $14 | $185 | $355 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $74 | $290 | $506 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $20 | $210 | $400 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $28 | $319 | $650 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $11 | $269 | $527 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $4 | $134 | $264 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $5 | $91 | $198 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $3 | $5 | $7 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $144 | $249 | $393 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $30 | $130 | $286 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $87 | $143 | $227 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $21 | $98 | $165 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $26 | $107 | $166 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $4 | $20 | $50 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $2 | $7 | $17 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $70 | $90 | $131 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $33 | $79 | $160 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $57 | $281 | $574 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $16 | $69 | $163 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $5 | $9 | $16 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $160 | $477 | $726 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $591 | $3,028 | $5,905 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $81 | $168 | $211 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $256 | $2,962 | $6,068 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $32 | $181 | $296 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $339 | $750 | $1,162 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $33 | $334 | $643 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $22 | $146 | $268 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $326 | $871 | $1,417 |
| Septoplasty CPT 30520 • ENT | $148 | $1,086 | $2,024 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $25 | $233 | $442 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $104 | $326 | $666 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $35 | $387 | $833 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $201 | $527 | $900 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $355 | $677 | $1,320 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $199 | $350 | $651 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $44 | $460 | $1,047 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $415 | $1,041 | $1,667 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $127 | $416 | $706 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $273 | $681 | $1,089 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $285 | $708 | $1,131 |