| Punch biopsy of skin single lesion CPT 11104 • Dermatology | $109 | $171 | $233 |
| Incisional biopsy of skin single lesion CPT 11106 • Dermatology | $135 | $209 | $282 |
| Shaving skin lesion trunk/arms/legs 0.5cm or less CPT 11300 • Dermatology | $4 | $63 | $182 |
| Shaving skin lesion trunk/arms/legs 0.6-1.0cm CPT 11301 • Dermatology | $106 | $165 | $224 |
| Shaving skin lesion scalp/neck/hands/feet 0.5cm or less CPT 11305 • Dermatology | $30 | $108 | $185 |
| Shaving skin lesion face 0.5cm or less CPT 11310 • Dermatology | $91 | $91 | $91 |
| Excision benign lesion trunk/arms/legs 0.5cm or less CPT 11400 • Dermatology | $233 | $233 | $233 |
| Excision benign lesion trunk/arms/legs 0.6-1.0cm CPT 11401 • Dermatology | $280 | $280 | $280 |
| Excision benign lesion trunk/arms/legs 1.1-2.0cm CPT 11402 • Dermatology | $218 | $218 | $218 |
| Excision benign lesion face 0.5cm or less CPT 11440 • Dermatology | $196 | $196 | $196 |
| Excision malignant lesion trunk/arms/legs 0.5cm or less CPT 11600 • Dermatology | $171 | $200 | $229 |
| Excision malignant lesion trunk/arms/legs 0.6-1.0cm CPT 11601 • Dermatology | $429 | $429 | $429 |
| Excision malignant lesion trunk/arms/legs 1.1-2.0cm CPT 11602 • Dermatology | $42 | $239 | $465 |
| Excision malignant lesion face 0.5cm or less CPT 11640 • Dermatology | $375 | $375 | $375 |
| Avulsion of nail plate partial or complete CPT 11730 • Dermatology | $187 | $187 | $187 |
| Destruction premalignant lesion first lesion CPT 17000 • Dermatology | $125 | $125 | $125 |
| Destruction premalignant lesion 2-14 each additional CPT 17003 • Dermatology | $1 | $6 | $11 |
| Destruction premalignant lesion 15 or more CPT 17004 • Dermatology | $190 | $190 | $190 |
| Destruction benign lesions up to 14 CPT 17110 • Dermatology | $132 | $132 | $132 |
| Destruction benign lesions 15 or more CPT 17111 • Dermatology | $114 | $130 | $163 |
| Photochemotherapy tar and UV-B CPT 96910 • Dermatology | $108 | $120 | $131 |
| Laser treatment dermatologic up to 250 sq cm CPT 96920 • Dermatology | $129 | $137 | $146 |
| Blood glucose test strip HCPCS A4253 • Durable Medical Equipment | $5 | $18 | $32 |
| Calibration solution glucose monitor HCPCS A4256 • Durable Medical Equipment | $2 | $5 | $11 |
| Crutches forearm each HCPCS E0110 • Durable Medical Equipment | $11 | $35 | $83 |
| Walker folding wheeled adjustable height HCPCS E0143 • Durable Medical Equipment | $40 | $71 | $101 |
| Hospital bed semi-electric HCPCS E0260 • Durable Medical Equipment | $134 | $256 | $377 |
| Portable gaseous oxygen system HCPCS E0431 • Durable Medical Equipment | $30 | $80 | $130 |
| Nebulizer compressor HCPCS E0570 • Durable Medical Equipment | $18 | $36 | $55 |
| Oxygen concentrator portable HCPCS E1390 • Durable Medical Equipment | $181 | $345 | $510 |
| Negative pressure wound therapy electric pump HCPCS E2402 • Durable Medical Equipment | $1,642 | $3,755 | $5,868 |
| Standard wheelchair HCPCS K0001 • Durable Medical Equipment | $52 | $124 | $197 |
| Power wheelchair group 2 standard HCPCS K0823 • Durable Medical Equipment | $2,196 | $2,747 | $3,849 |
| Cervical collar nonadjustable HCPCS L0180 • Durable Medical Equipment | $195 | $265 | $334 |
| Lumbar support corset HCPCS L0650 • Durable Medical Equipment | $1,310 | $1,310 | $1,310 |
| Knee orthosis adjustable joint HCPCS L1832 • Durable Medical Equipment | $363 | $544 | $725 |
| Foot insert removable molded HCPCS L3000 • Durable Medical Equipment | $168 | $213 | $302 |
| Submucous resection inferior turbinate CPT 30140 • ENT | $300 | $478 | $834 |
| Septoplasty CPT 30520 • ENT | $686 | $936 | $1,187 |
| Ablation inferior turbinate unilateral intramural CPT 30801 • ENT | $30 | $230 | $431 |
| Nasal endoscopy diagnostic CPT 31231 • ENT | $189 | $292 | $394 |
| Nasal endoscopy with biopsy CPT 31237 • ENT | $257 | $374 | $491 |
| Nasal/sinus endoscopy with ethmoidectomy partial CPT 31254 • ENT | $444 | $487 | $530 |
| Nasal/sinus endoscopy with ethmoidectomy total CPT 31255 • ENT | $326 | $552 | $777 |
| Nasal/sinus endoscopy with maxillary antrostomy CPT 31256 • ENT | $181 | $249 | $385 |
| Nasal/sinus endoscopy with frontal sinus exploration CPT 31267 • ENT | $617 | $617 | $617 |
| Nasal/sinus endoscopy with sphenoidotomy CPT 31276 • ENT | $980 | $980 | $980 |
| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $190 | $278 | $365 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $287 | $425 | $564 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $585 | $585 | $585 |