| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $49 | $128 | $269 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $144 | $268 | $335 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $60 | $96 | $161 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $30 | $97 | $163 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $39 | $47 | $62 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $74 | $104 | $156 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $79 | $118 | $166 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $133 | $154 | $202 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $133 | $164 | $198 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $30 | $87 | $131 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $188 | $192 | $196 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $212 | $217 | $223 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $240 | $251 | $278 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $197 | $197 | $197 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $30 | $72 | $172 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $30 | $53 | $63 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $2 | $12 | $30 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $153 | $181 | $209 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $30 | $93 | $147 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $87 | $120 | $133 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $91 | $111 | $133 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $66 | $121 | $175 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $5 | $5 | $5 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $2 | $2 | $2 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $52 | $61 | $67 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $8 | $22 | $45 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $49 | $68 | $96 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $14 | $67 | $155 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $5 | $39 | $65 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $63 | $345 | $795 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $573 | $2,913 | $6,694 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $23 | $96 | $230 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $262 | $1,558 | $2,624 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $208 | $293 | $377 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $815 | $815 | $815 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $436 | $488 | $577 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $188 | $238 | $263 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $270 | $320 | $374 |
| Septoplasty CPT 30520 • ENT | $552 | $583 | $614 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $214 | $214 | $214 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $133 | $179 | $194 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $247 | $325 | $362 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $344 | $372 | $401 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $320 | $325 | $330 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $178 | $213 | $231 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $30 | $240 | $402 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $374 | $375 | $376 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $130 | $196 | $325 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $284 | $335 | $407 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $30 | $276 | $425 |