| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $59 | $125 | $188 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $71 | $147 | $214 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $23 | $62 | $101 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $38 | $95 | $125 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $29 | $118 | $217 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $33 | $59 | $94 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $55 | $89 | $126 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $71 | $130 | $160 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $82 | $166 | $241 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $75 | $108 | $140 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $71 | $157 | $203 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $94 | $162 | $239 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $100 | $204 | $339 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $77 | $158 | $263 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $49 | $74 | $114 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $27 | $57 | $76 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $1 | $4 | $7 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $105 | $154 | $231 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $34 | $128 | $236 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $45 | $97 | $136 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $47 | $96 | $126 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $72 | $106 | $171 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $5 | $13 | $33 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $2 | $6 | $12 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $48 | $170 | $504 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $18 | $37 | $47 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $61 | $1,069 | $3,568 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $14 | $71 | $130 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $7 | $29 | $55 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $64 | $264 | $680 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $722 | $3,192 | $5,868 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $23 | $102 | $197 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $402 | $3,103 | $8,027 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $208 | $1,028 | $2,589 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $815 | $893 | $989 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $452 | $1,744 | $4,248 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $182 | $191 | $202 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $152 | $258 | $330 |
| Septoplasty CPT 30520 • ENT | $478 | $804 | $1,271 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $156 | $199 | $231 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $80 | $126 | $208 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $207 | $230 | $267 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $260 | $301 | $336 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $346 | $416 | $459 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $192 | $259 | $367 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $284 | $398 | $550 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $405 | $501 | $582 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $143 | $174 | $190 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $307 | $420 | $615 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $318 | $437 | $640 |