| Incision and drainage peritonsillar abscess CPT 42700 • ENT | $106 | $189 | $282 |
| Tonsillectomy and adenoidectomy under age 12 CPT 42820 • ENT | $251 | $343 | $436 |
| Tonsillectomy and adenoidectomy age 12 or older CPT 42821 • ENT | $165 | $438 | $895 |
| Tonsillectomy primary under age 12 CPT 42826 • ENT | $216 | $379 | $749 |
| Adenoidectomy primary under age 12 CPT 42830 • ENT | $111 | $281 | $529 |
| Removal impacted cerumen unilateral CPT 69210 • ENT | $28 | $56 | $81 |
| Tympanostomy tube insertion CPT 69436 • ENT | $140 | $179 | $238 |
| Tympanoplasty without mastoidectomy CPT 69631 • ENT | $459 | $1,167 | $2,250 |
| Tympanoplasty with mastoidectomy CPT 69633 • ENT | $840 | $1,250 | $1,550 |
| Comprehensive audiometry evaluation CPT 92557 • ENT | $32 | $40 | $48 |
| Incision and drainage abscess simple CPT 10060 • Emergency | $41 | $97 | $141 |
| Incision and drainage abscess complicated CPT 10061 • Emergency | $42 | $262 | $598 |
| Simple wound repair up to 2.5cm CPT 12001 • Emergency | $42 | $108 | $264 |
| Simple wound repair 2.6-7.5cm CPT 12002 • Emergency | $87 | $118 | $157 |
| Simple wound repair face 2.5cm or less CPT 12011 • Emergency | $69 | $122 | $186 |
| Intermediate wound repair 2.5cm or less CPT 12031 • Emergency | $91 | $206 | $338 |
| Intermediate wound repair face 2.5cm or less CPT 12051 • Emergency | $120 | $322 | $642 |
| Initial treatment first degree burn CPT 16000 • Emergency | $25 | $77 | $112 |
| Emergency department visit self-limited problem CPT 99281 • Emergency | $16 | $25 | $31 |
| Emergency department visit low severity CPT 99282 • Emergency | $37 | $65 | $98 |
| Emergency department visit moderate severity CPT 99283 • Emergency | $58 | $85 | $130 |
| Emergency department visit high severity CPT 99284 • Emergency | $101 | $146 | $196 |
| Emergency department visit highest severity CPT 99285 • Emergency | $188 | $277 | $479 |
| Critical care first 30-74 minutes CPT 99291 • Emergency | $42 | $333 | $661 |
| Critical care each additional 30 minutes CPT 99292 • Emergency | $88 | $173 | $294 |
| Esophagoscopy rigid diagnostic CPT 43191 • Gastroenterology | $145 | $165 | $189 |
| Upper GI endoscopy diagnostic CPT 43235 • Gastroenterology | $42 | $389 | $799 |
| Upper GI endoscopy with biopsy CPT 43239 • Gastroenterology | $42 | $322 | $578 |
| Upper GI endoscopy with foreign body removal CPT 43247 • Gastroenterology | $201 | $545 | $1,220 |
| Upper GI endoscopy with balloon dilation CPT 43249 • Gastroenterology | $42 | $1,093 | $3,224 |
| Upper GI endoscopy with polypectomy by snare CPT 43251 • Gastroenterology | $119 | $392 | $731 |
| Upper GI endoscopy with stent placement CPT 43257 • Gastroenterology | $168 | $381 | $697 |
| Upper GI endoscopy with endoscopic ultrasound CPT 43259 • Gastroenterology | $228 | $349 | $595 |
| ERCP diagnostic CPT 43260 • Gastroenterology | $326 | $422 | $511 |
| ERCP with sphincterotomy CPT 43262 • Gastroenterology | $317 | $467 | $566 |
| ERCP with removal of stones CPT 43264 • Gastroenterology | $368 | $638 | $1,118 |
| ERCP with stent placement CPT 43274 • Gastroenterology | $468 | $738 | $1,400 |
| Colonoscopy through stoma diagnostic CPT 44388 • Gastroenterology | $42 | $286 | $510 |
| Colonoscopy through stoma with biopsy CPT 44389 • Gastroenterology | $253 | $457 | $573 |
| Colonoscopy diagnostic CPT 45378 • Gastroenterology | $42 | $362 | $565 |
| Colonoscopy with biopsy CPT 45380 • Gastroenterology | $42 | $407 | $674 |
| Colonoscopy with submucosal injection CPT 45381 • Gastroenterology | $42 | $458 | $1,176 |
| Colonoscopy with lesion removal by hot biopsy CPT 45384 • Gastroenterology | $208 | $355 | $520 |
| Colonoscopy with polypectomy by snare CPT 45385 • Gastroenterology | $42 | $406 | $761 |
| Colonoscopy with balloon dilation CPT 45386 • Gastroenterology | $145 | $839 | $2,001 |
| Colonoscopy with ablation of tumor or polyp CPT 45388 • Gastroenterology | $284 | $1,234 | $2,717 |
| Colonoscopy with endoscopic mucosal resection CPT 45390 • Gastroenterology | $336 | $501 | $846 |
| Esophageal motility study CPT 91010 • Gastroenterology | $119 | $186 | $253 |
| Esophageal motility study with acid reflux CPT 91035 • Gastroenterology | $82 | $498 | $1,467 |
| Esophageal pH monitoring 24 hours CPT 91038 • Gastroenterology | $51 | $190 | $398 |