| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $107 | $148 | $188 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $87 | $108 | $130 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $83 | $105 | $150 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $102 | $142 | $182 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $42 | $100 | $157 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $42 | $108 | $174 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $42 | $82 | $122 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $42 | $136 | $229 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $255 | $255 | $255 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $88 | $149 | $209 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $164 | $230 | $296 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $42 | $193 | $343 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $212 | $264 | $369 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $171 | $179 | $188 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $42 | $61 | $80 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $42 | $61 | $80 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $9 | $25 | $42 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $144 | $144 | $144 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $94 | $97 | $100 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $112 | $140 | $196 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $64 | $97 | $131 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $70 | $103 | $136 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $3 | $4 | $5 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $1 | $2 | $2 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $30 | $52 | $64 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $22 | $42 | $62 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $27 | $390 | $753 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $7 | $95 | $184 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $3 | $55 | $107 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $35 | $520 | $1,005 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $312 | $4,682 | $9,052 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $10 | $20 | $30 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $316 | $1,421 | $3,169 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $128 | $163 | $198 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $354 | $354 | $354 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $256 | $327 | $397 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $104 | $141 | $161 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $142 | $358 | $466 |
| Septoplasty CPT 30520 • ENT | $516 | $586 | $657 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $174 | $174 | $174 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $50 | $136 | $222 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $202 | $237 | $273 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $288 | $312 | $336 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $258 | $340 | $423 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $143 | $187 | $209 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $42 | $126 | $210 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $42 | $171 | $300 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $154 | $187 | $221 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $230 | $283 | $337 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $42 | $141 | $240 |