| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $115 | $154 | $199 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $74 | $109 | $143 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $43 | $85 | $106 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $111 | $125 | $139 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $48 | $73 | $98 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $41 | $87 | $132 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $95 | $95 | $95 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $124 | $187 | $250 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $137 | $144 | $157 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $159 | $159 | $159 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $227 | $227 | $227 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $269 | $269 | $269 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $251 | $271 | $291 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $236 | $236 | $236 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $118 | $118 | $118 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $49 | $75 | $111 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $3 | $6 | $9 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $120 | $120 | $120 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $128 | $157 | $185 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $102 | $119 | $136 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $87 | $105 | $122 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $165 | $180 | $196 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $8 | $13 | $19 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $3 | $4 | $6 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $37 | $79 | $104 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $60 | $84 | $117 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $79 | $386 | $692 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $18 | $128 | $239 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $11 | $55 | $100 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $107 | $677 | $1,248 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $971 | $5,864 | $10,758 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $30 | $149 | $267 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $341 | $2,463 | $4,027 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $198 | $243 | $288 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $774 | $774 | $774 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $58 | $354 | $575 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $179 | $215 | $233 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $32 | $559 | $1,117 |
| Septoplasty CPT 30520 • ENT | $530 | $643 | $756 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $272 | $272 | $272 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $79 | $220 | $352 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $306 | $425 | $658 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $336 | $433 | $530 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $384 | $439 | $493 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $213 | $223 | $243 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $391 | $391 | $391 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $623 | $623 | $623 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $101 | $220 | $326 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $359 | $414 | $504 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $373 | $373 | $373 |