| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $72 | $211 | $310 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $87 | $228 | $379 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $52 | $107 | $247 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $61 | $139 | $296 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $56 | $124 | $257 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $70 | $158 | $282 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $127 | $173 | $306 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $105 | $199 | $370 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $115 | $219 | $407 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $142 | $199 | $342 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $131 | $248 | $474 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $146 | $294 | $543 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $253 | $372 | $580 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $171 | $267 | $479 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $64 | $168 | $315 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $55 | $90 | $154 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $3 | $26 | $88 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $154 | $170 | $203 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $110 | $155 | $271 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $82 | $170 | $315 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $79 | $185 | $297 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $73 | $128 | $207 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $5 | $20 | $52 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $2 | $5 | $12 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $7 | $48 | $110 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $6 | $53 | $137 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $65 | $610 | $1,716 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $21 | $203 | $388 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $14 | $117 | $228 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $955 | $1,847 | $3,056 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $62 | $7,770 | $20,971 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $294 | $418 | $755 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $2,759 | $3,844 | $4,916 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $198 | $300 | $435 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $549 | $927 | $1,335 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $427 | $562 | $808 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $194 | $281 | $375 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $175 | $311 | $494 |
| Septoplasty CPT 30520 • ENT | $702 | $1,106 | $1,667 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $224 | $269 | $360 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $92 | $277 | $504 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $231 | $463 | $635 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $238 | $505 | $1,091 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $330 | $450 | $508 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $249 | $302 | $419 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $377 | $503 | $619 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $537 | $734 | $881 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $202 | $303 | $491 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $351 | $498 | $692 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $366 | $506 | $729 |