| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $56 | $190 | $257 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $153 | $241 | $320 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $30 | $38 | $41 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $30 | $43 | $60 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $30 | $48 | $77 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $30 | $60 | $129 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $30 | $60 | $92 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $30 | $71 | $171 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $41 | $127 | $189 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $30 | $132 | $300 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $30 | $125 | $220 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $41 | $95 | $168 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $41 | $100 | $276 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $183 | $278 | $424 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $30 | $70 | $124 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $30 | $46 | $73 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $7 | $30 | $41 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $30 | $65 | $111 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $30 | $59 | $124 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $41 | $67 | $146 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $110 | $182 | $252 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $66 | $218 | $295 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $3 | $3 | $3 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $1 | $2 | $3 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $6 | $45 | $65 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $4 | $31 | $44 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $33 | $33 | $33 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $8 | $8 | $8 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $4 | $40 | $77 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $42 | $484 | $927 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $382 | $382 | $382 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $13 | $142 | $270 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $959 | $2,000 | $3,041 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $140 | $362 | $473 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $548 | $944 | $1,492 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $304 | $482 | $800 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $127 | $233 | $397 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $30 | $390 | $607 |
| Septoplasty CPT 30520 • ENT | $41 | $269 | $725 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $160 | $200 | $219 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $30 | $46 | $73 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $30 | $354 | $552 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $278 | $695 | $904 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $30 | $121 | $370 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $205 | $278 | $306 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $30 | $104 | $303 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $30 | $287 | $610 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $152 | $321 | $415 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $30 | $348 | $518 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $30 | $363 | $541 |