| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $39 | $118 | $197 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $115 | $140 | $166 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $21 | $32 | $38 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $63 | $98 | $133 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $37 | $83 | $166 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $57 | $57 | $57 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $77 | $168 | $225 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $95 | $171 | $246 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $106 | $106 | $106 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $66 | $146 | $227 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $119 | $168 | $216 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $147 | $147 | $147 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $162 | $311 | $385 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $122 | $125 | $127 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $67 | $124 | $181 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $53 | $85 | $107 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $2 | $14 | $38 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $119 | $191 | $264 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $73 | $144 | $180 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $58 | $159 | $210 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $51 | $86 | $120 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $133 | $153 | $173 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $6 | $15 | $23 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $2 | $4 | $6 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $13 | $43 | $67 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $35 | $40 | $46 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $45 | $61 | $76 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $17 | $69 | $121 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $7 | $9 | $10 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $105 | $400 | $695 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $932 | $3,049 | $5,165 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $34 | $152 | $270 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $218 | $1,770 | $3,041 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $194 | $203 | $212 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $593 | $609 | $624 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $359 | $517 | $799 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $167 | $177 | $183 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $315 | $415 | $465 |
| Septoplasty CPT 30520 • ENT | $447 | $756 | $1,065 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $160 | $160 | $160 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $138 | $242 | $294 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $144 | $317 | $403 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $219 | $339 | $460 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $323 | $344 | $365 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $158 | $239 | $279 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $255 | $333 | $411 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $38 | $343 | $585 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $38 | $67 | $97 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $211 | $377 | $460 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $220 | $346 | $481 |