| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $123 | $225 | $326 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $152 | $278 | $404 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $30 | $108 | $263 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $119 | $218 | $317 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $275 | $275 | $275 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $303 | $303 | $303 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $332 | $332 | $332 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $276 | $276 | $276 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $167 | $234 | $301 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $373 | $373 | $373 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $193 | $255 | $317 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $386 | $386 | $386 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $30 | $301 | $637 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $30 | $279 | $528 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $78 | $189 | $299 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $174 | $174 | $174 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $17 | $17 | $17 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $438 | $438 | $438 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $64 | $179 | $294 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $30 | $167 | $344 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $112 | $206 | $301 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $152 | $279 | $405 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $3 | $6 | $8 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $1 | $3 | $3 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $13 | $42 | $73 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $29 | $41 | $53 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $38 | $53 | $69 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $10 | $94 | $178 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $4 | $6 | $7 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $50 | $71 | $92 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $440 | $4,255 | $8,071 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $15 | $142 | $270 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $166 | $1,829 | $3,041 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $160 | $264 | $368 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $419 | $717 | $1,015 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $348 | $649 | $800 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $145 | $270 | $333 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $30 | $262 | $466 |
| Septoplasty CPT 30520 • ENT | $665 | $1,219 | $1,774 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $571 | $571 | $571 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $169 | $176 | $183 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $250 | $333 | $417 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $431 | $533 | $635 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $317 | $581 | $845 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $30 | $177 | $470 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $259 | $476 | $693 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $986 | $986 | $986 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $30 | $191 | $504 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $284 | $524 | $765 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $297 | $549 | $801 |