| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $6 | $56 | $106 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $26 | $79 | $132 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $3 | $43 | $85 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $78 | $93 | $103 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $9 | $9 | $9 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $20 | $20 | $20 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $17 | $63 | $110 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $46 | $56 | $66 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $73 | $87 | $101 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $9 | $9 | $9 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $21 | $21 | $21 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $90 | $90 | $90 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $32 | $32 | $32 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $11 | $93 | $175 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $4 | $4 | $4 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $10 | $33 | $57 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $2 | $4 | $6 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $13 | $13 | $13 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $30 | $63 | $95 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $55 | $83 | $112 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $21 | $64 | $106 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $64 | $96 | $128 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $4 | $4 | $5 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $2 | $2 | $2 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $52 | $61 | $70 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $4 | $24 | $44 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $57 | $244 | $430 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $13 | $113 | $164 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $5 | $29 | $53 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $60 | $286 | $726 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $591 | $3,248 | $5,905 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $158 | $158 | $158 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $256 | $1,408 | $2,560 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $32 | $123 | $213 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $34 | $186 | $338 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $65 | $65 | $65 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $30 | $88 | $147 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $245 | $245 | $245 |
| Septoplasty CPT 30520 • ENT | $519 | $519 | $519 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $33 | $33 | $33 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $21 | $131 | $208 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $44 | $221 | $329 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $481 | $481 | $481 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $36 | $195 | $355 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $30 | $115 | $199 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $291 | $291 | $291 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $208 | $208 | $208 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $124 | $124 | $124 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $191 | $191 | $191 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $284 | $284 | $285 |